Resultados do sling transobturatório em um seguimento superior a cinco anos: experiência de 152 casos com o mesmo cirurgião

Abstract

Introduction: Transobturator sling is one of the most accomplished surgeries in the treatment of female urinary incontinence (UI), but there are still few long-term studies to evaluate its efficacy and complications when performed by a single surgeon. Objective: To evaluate the long-term subjective cure rate of the transobturator sling, to analyze the risk factors for failure and the influence of the learning curve on the cure rate and on the occurrence of complications. Methods: A retrospective cohort study was performed with patients submitted to transobturator sling surgery performed by the author from 2005 to 2011. Patients who agreed to participate in the study were interviewed by phone (by two researchers other than the author) and after informed consent, they answered the ICIQ-SF plus questions about the current degree of satisfaction with the surgery performed. We considered ICIQ-SF equal to zero as a criterion of cure. Clinical, urodynamic, intraoperative and postoperative data were obtained from medical records and were used in the analysis of risk factors for failure and complications. Pearson's Chi-square test (X2) and Fisher's Exact Test were used to analyze the categorical variables. The Odds Ratio was calculated to determine the prognostic values of risk factors for surgical failure. The learning curve in years was correlated with rates of cure and complications. Results: Of the 215 patients operated, 152 (70.6%) accepted to participate in the study. The median follow up was 87 months and the mean age was 51.5 years. The urodynamic diagnosis was of stress urinary incontinence (SUI) in 144 patients (94.7%) and of mixed urinary incontinence (MUI) in 8 (5.3%). Complications occurred in 25 (16%) patients. After application of ICQ-SF 99 (65.10%) patients were cured (ICIQ-SF = 0). Regarding degree of satisfaction, 101 (66%) were considered cured, 43 (28%) improved, 7 (4.6%) unchanged and one related worsening of incontinence. After univariate analysis the risk factores for surgical failure were the presence of urgency (p <0.001) and the age. Conclusion: The transobturator sling is effective in the surgical treatment of UI and has a low rate of complications and a high satisfaction rate in the long term. The man risk factor for failure was the presence of urgency. The learning curve did not interfere in the reduction of complications in this sample. These results produced by a single surgeon probably represent those found in clinical practice.