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[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].

Abstract：

OBJECTIVE:The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS:The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS:16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS:Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

journal_name

Arch Esp Urol

journal_title

Archivos espanoles de urologia

authors

Marqués Queimadelos A,Abascal García R,Muruamendiaraz Fernández V,Virseda Rodríguez J,Arañó Bertran P,Fernández Fernández E,Sousa Escandón A,Cimadevila García A,Cimadevila Covelo A,Rios Tallón YL

subject

Has Abstract

pub_date

1999-10-01 00:00:00

pages

877-80

issue

eissn

0004-0614

issn

1576-8260

journal_volume

pub_type

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[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].