SIA Annual Meeting 2006

Urinary incontinence in Women: A Questionnaire Study of social and sexual quality of life

Andrea Ceresoli, Fulvio Colombo, Ai Ling Romanò, Laura Rivolta

INTRODUCTION
Female urinary incontinence (UI) is a well known clinical-social condition that adversely affects social and sexual activities of female patients. This study intended to evaluate the impact of urinary incontinence on social and sexual quality of life and to understand the reasons underlying the delay in recourse to medical care: it also aimed at rating post-operative satisfaction after a minimally invasive corrective surgery

METHODS
From January 2002 through December 2005, we evaluated 176 outpatients who had arrived at our clinics either for urinary incontinence-related problems (104 patients) or for surgery follow-up visits (48 patients, at least 4 years post-surgery) or for other reasons. After administration of the integrated ICIQ-LF questionnaire, the UI patients were divided into groups: stress urinary incontinence (SUI): 46 patients; detrusor hyperreflexia (DH): 36 patients: Urgency/Frequency Syndrome (UF): 22 patients. The group of patients who had already undergone surgery for SUI included 48 subjects (OP), and the control group included 24 health patients (CG).

RESULTS
The overall quality of life was noted to be worse, compared to the GC, in the DH and UF groups. These two groups were noted to have poorer scores also in the sexual life domain. Ten percent of SUI patients were noted to have requested at least one specialistic visit. In 70% of cases, the loss of urine was not considered a sufficient reason for recourse to specialistic treatment. Ninety five percent of women who had undergone minimally invasive surgery reported they had completed resumed their social and sexual activities. Ninety percent of these patients stated they had overestimated the possible negative emotional issues related to surgery, as the latter had in practice been actually/truly minimally invasive.

CONCLUSIONS
Urinary incontinence and voiding frequency do affect quality of life and sexuality in women. It is important to provide complete and detailed information with respect to therapy, pharmacological and minimally invasive surgery options in order to ensure improvement of social and sexual quality of life.

Per lei mini-lifting molto intimo

Estratto Da TGcom Tg magazine del 26/9/2006

Per lei mini-lifting molto intimo
Garantisce sesso anche a 60 anni

Un intervento mini-invasivo, rapido, indolore e definitivo risolleva muscoli e tessuti dell'apparato genitale, e restituisce alla donna non più giovane un'anatomia praticamente perfetta. Insomma, si potrà fare sesso come all’età dei primi appuntamenti: dimenticati disfunzioni, disturbi e imbarazzi, la paziente ritrova desiderio e passione.

Il Direttore della clinica urologica dell'Ospedale San Giuseppe di Milano, ha studiato e sperimentato per la vagina un intervento mininvasivo che "ringiovanisce" i tessuti, come accade per quelli del viso, che dopo una certa età si rilasciano e abbisognano di un intervento di lifting, La tecnica dal 2001 al 2006 è stata applicata a 48 pazienti ed è stata “esportata” in 12 centri in tutta Italia già in grado di offrirla: le strutture si trovano a Torino, Chioggia (Venezia), Asiago (Vicenza), Napoli, Torre del Greco (Napoli), Pozzuoli (Napoli), Salerno, Rionero (Potenza), Foggia, S.Giovanni Rotondo (Foggia), Cerignola (Foggia) e Catanzaro. La metodica si serve di un nuovo dispositivo a forma di fazzoletto, una specie di reticella semiassorbibile in polipropilene, sagomata in modo da garantire un trattamento dall'esito risolutivo. "Il desiderio sessuale è una modulazione fra eccitazione e inibizione. Ed è chiaro che alcuni disturbi possono bloccare psicologicamente la donna, specie nei preliminari, per non parlare del dolore durante la penetrazione e nel corso del rapporto". Questi disturbi sono causati dal rilasciarsi e dall'abbassamento dei tessuti. "In particolare - interviene Andrea Ceresoli - dal disallineamento che con il tempo si crea fra vescica e uretra".
L'intervento consiste nell’introdurre nel condotto vaginale una reticella larga uno o due centimetri. Una volta inserita, grazie al materiale con cui è fatta, questa reticella stimola le cellule circostanti a produrre una cicatrice resistente (reazione fibroblastica), che permette di mantenere la sua posizione originaria. Subito dopo la parte centrale, riassorbibile, si scioglie. In questo modo le due 'alette' che rimangono intatte si ripiegano, e tengono sollevati muscoli e tessuti senza toccare uretra o vescica.
"Calcoliamo che il nostro intervento possa cambiare la vita a 1,6 milioni di donne italiane di cui oltre 250mila in Lombardia e quasi 50mila a Milano". La stessa operazione serve anche a curare l'incontinenza urinaria da sforzo, che colpisce 5 milioni di italiani di cui oltre due milioni di donne ultra 60enni.
Come spiega Andrea Ceresoli, che esegue l'intervento al San Giuseppe, l’80% delle donne che, dopo una certa età, lamentano disturbi tali da indurle a interrompere i rapporti sessuali, presenta un vero e proprio prolasso di muscoli e tessuti dell'apparato genitale. La vecchia metodica mini-invasiva riusciva bene solo nel restante 20%. Oltre metà delle pazienti con prolasso, invece, mostrava ricadute entro i cinque anni successivi. La tecnica invasiva era sempre efficace, ma dolorosa e più complessa, con ricoveri lunghi e molti mesi di convalescenza.
Da qui i vantaggi del nuovo minilifting: zero ricadute di prolasso, 7-8 minuti di intervento (20-60 minuti di sala operatoria), da uno a tre giorni in ospedale e due mesi di convalescenza, in cui evitare sforzi e rapporti

SIUD Annual Meeting 2007

Differentiated polypropylene tension free sling (T-Sling) in noninvasive treatment of pubocervical fascia defects. 5-year follow up

Authors : Ceresoli A, Guarneri A, Colombo F, Seveso M, Grasso Macola G, Cazzaniga A, Romano’ Ai Ling
Institution: Cattedra di Urologia II di Milano – Ospedale Classificato “San Giuseppe”


INTRODUCTION AND AIM OF THE STUDY
Effectiveness and tolerance of a differentiated polypropylene (PP) partially absorbable tension-free sling deliverable by transobturator (TO) access in vaginal treatment of cystocele associated with type II stress urinary incontinence was assessed in a 5 – year retrospective study.

MATERIALS AND METHODS
The T-Sling is a mesh composed of 2 different materials.The 2 lateral aspects of the mesh are composed of a 2 cm-width monofilament nonabsorbable polypropylene mesh with a 1-cm center absorbable monofilament of polydioxanone (PDO).After anterior repair the T sling has been delivered by TO access and alligned under the proximal urethra and the bladder. All patients had a urinary questionaire, voiding diary,preoperative multichannel urodynamics studies and cystography. Cure was defined as subjective patient satisfaction with negative objective evaluation.Failure as subjective patient’s unsatisfaction and poor objective results.Improvement was defined as not having achieved the results of cure.48 patients with grade II and III anterior wall prolapse according to Baden Walker classification , had been treated by vaginal route with cystocele repair and interposition of the differentiated PP tension freee sling positioned underneath the proximal urethra and the bladder neck with TO approach.22(45,8%) had grade IIa and 16(33,3%) grade IIb anterior vaginal prolapse with stress urinary incontinence secondary to urethral hypermobility.10(20,8%) patients without preoperative stress urinary incontinence had grade III anterior vaginal prolapse symptomatic for low urinary tract syndrome

RESULTS
Cure was reached in 44 (91,6%) of the patients, improvement was found in 3 patients (6,2%). Early postoperative complications were 3 cases of urinary infection - treated successfully with wide spectrum antibiotics- and 1 local cutaneous hematoma reabsorbed in 15 days.There were observed 1 early urethral erosion, 2 early vaginal erosion and 3 late vaginal erosion. Excision of single side of the mesh was sufficient to cure patient preserving functional results. No incidence of de novo detrusor instability or cystocele recurrence has been showed in the long term follow up ranging from 6 to 65 months, mean 42,2 months . 3 (6,2%) patients complained partial urinary incontinence relapse within 4 months from operation

DISCUSSION
Polypropylene has long term follow up showing excellent results providing a durable framework for the in – growth of collagen with a high tolerance to infection and has been found to be safely used in the treatment of Stress Urinary Incontinence (SUI) .
Synthetic material should provide a nonantigenic framework that is gradually interlaced or replaced by host fibroplasia resulting in a strong stable aponeurotic structure.Within a twelve month interval synthetic flat meshes shrink up to 20-30% contribuiting to an increase in pressure on the urethra or contigous organs causing tardive retention and urethral erosion leading to a secondary surgical procedure. These harmful complications however may suggest not to place synthetic slings against visceral organs such as bladder and urethra, if possible. There is also an evidence indicating a relationship between post-operative complications and the mesh design with a correlation between voiding disorders after sling procedure and distance of the sling from the bladder neck. Incorporation of absorbable PDO material central into the design of the sling allows a surgical implantation of PP away from the urethra and the bladder neck in a tension free fashion preserving urethral vascular supply , mucosal seal and preventing from tardive outlet obstruction. When the PP material is placed into the body a fibroblastic reaction is produced that is immediate and allows it to remain in place. After hydrolysis dissolved the central portion, the 2 non absorbable portion are detached from themselves rendering a true “tension free sling” under the urinary tract and far away from direct contact of the urethra and bladder. .When placed from one arcus tendinous to the other the 2 ends of PP create a fibroblastic reaction rebuilding the primary anatomic preoperative defect of the pubocervical fascia by secondary intention.


CONCLUSION
In these series vaginal implantation of the new differentiated PP, partially absorbable T-Sling has been shown to be an effective procedure alternative to open surgery procedures in treatment of the cystocele associated with urethral hypermobility. Differentiated PP T-Sling procedure when delivered via TO approach showed no major perioperative complications , resulting in a efficient minimally invasive technique with a short hospital stay and low morbidity either at short term results and at medium follow up


REFERENCES
1) Kuo HC Anatomical and functional results of pubovaginal sling procedure using polypropylene mesh for the treatment of stress urinary incontinence, J.Urology. 2001;166:152-157
2) Delorme E,Droupy S,de Tayrac R,Delmas V Transobturator tape (Uratape):a new minimally-invasive procedure to treat female urnary incontinence. Eur.Urol. 2004 Feb;45(2):203-7