Objective. To evaluate the state of art of the three main minvasive antincontinence surgical routes: Prepubic, Retropubic and Trans-Obturator. Material and methods.A search of PubMed, Cochrane library and relevant articles from 1996 to 2011. Results. 70 works were found. Literature showed similar cure rates among retropubic (71,4-91%), trans-oburator (77,3-95%) and prepubic (81-87,2%) antincontinence procedures. Cystoscopy is considered necessary in the retropubic optional in transobturator, non-necessary in the prepubic. Intraoperative cough stress test is believed useful only in the retropubic and prepubic. Obstruction symptoms prevails in the retropubic, are rare in the transobturator and missing in the prepubic. Erosion rate is similar for the all three techniques. Permanent catheterization is found in 3% of the retropubic. The retropubic may be mainly offered for cure of recurrent stress incontinence and intrinsic sphincter deficiency (ISD) in absence of obstructive symptoms. Intraoperative vascular and perforating risks prevail in the retropubic due to the danger of the retropubic space, whereas late infective complications overcome in the transobturator owing to the site of the mesh tip that may interfere with thigh movements. Severe complications in the prepubic were not reported, but the procedure is performed in rare centres.
|Titolo:||Retropubic, transobturator and prepubic mininvasive antincontinence procedures: state of art.|
|Data di pubblicazione:||2011|
|Appare nelle tipologie:||1.1 Articolo in rivista|