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2

SLING INCONTINENCIA

por
Dr. Juan Pablo Roubicek
en 31/10/22 13:31 234 vistas

No, no lo cubrimos nosotros, pero se puede pedir a la o.social extracapita, según que tiene el afiliado.
A veces lo autorizan ellos
La cobertura que damos es para el código de nomenclador 100211 tratamiento de la incontinencia (a valores de convenio según nomenclador nacional, no con rpesupuestos)
No proveemos la maya (sling) ni ninguna diferencia por sling
Pero si se lo hacen por ese código y paga la malla el afiliado que se lo haga.

Hay mucha controversia sobre la efectividad y efectos adversos a largo plazo con sling

 

Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Brubaker L, Norton PA, Albo ME, Chai TC, Dandreo KJ, Lloyd KL, Lowder JL, Sirls LT, Lemack GE, Arisco AM, Xu Y, Kusek JW, Urinary Incontinence Treatment Network. Am J Obstet Gynecol. 2011;205(5):498.e1. Epub 2011 Jul 20

 

https://pubmed.ncbi.nlm.nih.gov/7818611/


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Trabaje muchos años con "el" colocador de Slings para PAMI en el Hospital Dr Carlos Sorondo. El gold standart inicialmente fue la tecnica de Burch, luego paso a ser la TVT.. posteriromente paso a usarse la via transobturatriz TOTque bajo el indice de complicaciones en perforaciones vasculares y vesicales., este a su vez bajo el indice de eficacia (de un 90% a un 80%) para adultos mayores , el descenso es un porcentaje aceptable. Despues aparecio el mini sling, que se coloca con anestesia local y la eficacia fue menor del 50% por lo que se abando.

El exito de la cirugia nombrado depende basicamente del operador entrenado o no y de la seleccion del paciente : Obesidad, actividad, actividad sexual (tot genera mucha dispareunia)edad, etc

Tomando un total de los procedimientos del hospital: unos 230 casos aprox en 5 años , la curacion fue del 80% aprox

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1

Trabaje muchos años con "el" colocador de Slings para PAMI en el Hospital Dr Carlos Sorondo. El gold standart inicialmente fue la tecnica de Burch, luego paso a ser la TVT.. posteriromente paso a usarse la via transobturatriz TOTque bajo el indice de complicaciones en perforaciones vasculares y vesicales., este a su vez bajo el indice de eficacia (de un 90% a un 80%) para adultos mayores , el descenso es un porcentaje aceptable. Despues aparecio el mini sling, que se coloca con anestesia local y la eficacia fue menor del 50% por lo que se abando.

El exito de la cirugia nombrado depende basicamente del operador entrenado o no y de la seleccion del paciente : Obesidad, actividad, actividad sexual (tot genera mucha dispareunia)edad, etc

Tomando un total de los procedimientos del hospital: unos 230 casos aprox en 5 años , la curacion fue del 80% aprox

  • Flag


1

Sumo Revision de Cochrane

Cochrane Database Syst Rev. 2017 Jul; 2017(7): CD006375.

Published online 2017 Jul 31. doi: 10.1002/14651858.CD006375.pub4

 

Copio lo que me parece mas relevante para la discusion.

No hay diferencias significativas con colposuspension abierta o laparoscopica.

No hay estudios a largo plazo.

La calidad de la evidencia es baja y moderada.

Mid-urethral sling operations versus open retropubic colposuspension

Although 14 RCTs were found that compared TVT operations with colposuspension (Lapitan 2012), data from five of them showed no clear diJerences in the short- or medium-term chance of incontinence compared with open colposuspension. While there were more complications aOer the sling operations, the numbers were small.

Mid-urethral sling operations versus laparoscopic colposuspension

Another Cochrane review identified eight trials that compared mid urethral sling operations to laparoscopic colposuspension (Dean 2006). Overall, the review showed that the subjective cure rates were similar for both of these minimal access techniques in the short term, while operation times were shorter for the slings. Longterm data are lacking, however.

A U T H O R S '   C O N C L U S I O N S

Implications for practice Mid-urethral sling operations are now widely accepted as a routine surgical treatmentfor stress urinary incontinence (SUI). This review has identified evidence that addresses the comparative eJects of diJerent ways of inserting tapes, including diJerent insertion routes, surgical approaches and tapes. Irrespective of the routes traversed, these procedures are highly eJective in the short and medium term and mounting evidence demonstrates their eJectiveness in the long term. There is low to moderate quality evidence that retropubic tapes and transobturator tapes have comparable eJects on cure of incontinence between one and five years, and limited evidence for the same in the long term. With the exception of a two-fold increase in the incidence of groin pain, transobturator tapes have fewer adverse events. Retropubic tapes have an eight-fold increase in the incidence of bladder perforation and a two-fold increase in the incidence of post operative voiding diJiculties. Although women's outcomes for quality of life and sexual function improved significantly aOer all surgical approaches, our analyses could not establish whetherthere was any diJerence between retropubic and transobturatortapes. Evidence for longer-term eJects is required to evaluate the need for further surgery following either approach.There was moderate quality evidence that when a retropubic route (RTR) is employed a bottom-to-top approach is more eJective in terms of subjective cure than a top-to-bottom approach. When traversing the transobturator route (TOR), there was moderate quality evidence showing that medial-to-lateral ('inside-out') and lateral-to-medial ('outside-in') approaches have similar eJects.

Implications for research

Many trials have evaluated the use of mid-urethral tapes in the short term. However, the long-term eJects of surgery, and how the diJerent insertion routes aJect long-term outcome, have not been established. It is unfortunate that although 35 of the 81 trials included should be in a position to report their long-term data (i.e. over five years), only three have done so. More of the trials included in this review should publish the results of their longerterm follow-up to increase the robustness of evidence supporting the use of mid-urethral sling (MUS) in the long term, to provide answers about the long-term adverse events of these operations, including whether there is a significant decline in the eJectiveness of these procedures over time, and to identify the point at which decline becomes significant enough to require women to need repeat procedures. More research is required into trials assessing the clinical eJectiveness of diJerent routes (RPR or TOR) in women with urodynamic stress incontinence where hypermobility is diJerentiated from intrinsic urethral sphincter deficiency, as data for most of the outcomes are sparse. Equally, trials assessing the eJectiveness of RPR or TOR in a cohort of women presenting with recurrent SUI aOer a failed MUS procedure are needed. More adequately powered trials are needed to address the issue of MUS in women who also have symptomatic or asymptomatic pelvic organ prolapse, as presently it is unclear whether concomitant pelvic organ prolapse surgery is necessary, and, if performed, whether it enhances or detracts from the eJectiveness of the MUS. Conversely, there is only indirect evidence to suggest that MUS are more eJective than anteriorrepair, as noRCTs have comparedthem directly. Future randomised controlled trials should be robustly designed to be of good quality and adequately powered with standardised woman-reported (subjective) outcome measures and objective outcomes. When reporting,these trials should follow the CONSORT guidelines (Moher 2001; Schulz 2010). There needs to be longterm follow-up and adequate reporting of adverse eJects. It is essential that outcomes relevant to both women and policy makers who commission treatments are incorporated into these trials. In particular, quality of life, sexual function and economic implications should be assessed. 

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Preguntado: 31/10/22 13:31
Visto: 234 veces
Última actualización: 26/3/23 06:01