OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6%): urinary bladder perforation in 3 patients (5%, p = 0.0228) and parietal peritoneum perforation in 1 case (1.6%). No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6%) and overcorrection in TVT-O (1%) which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04%) with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100% of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

Objective: To review the results obtained in our experience in the application of TVT-O for surgical correction of stress urinary incontinence (SUI). Patient and Method: Prospective pursuit of 135 patients submissive TVT-O in Las Condes Clinic. Results: The median age was 55 years (R: 38 to 74 years), BMI 27.5 (R: 23 to 34) and vaginal parity 2 (R: 0 to 5). Media operating time was 7 minutes (R: 4 to 17 minutes). One intraoperative complication appeared corresponding to the passage of the tape through urethra. Seven patients developed complications in immediate operative time. Five cases presented urinary retention. In them the tape was readjusted to 48 hours by ambulatory procedure. Hematomas and infections of the wounds were not registered. The discharge at home occurred in the cases of TVT-O without other surgery association at 12 hours. In remote operative period a case of tape exposition in the anterior vaginal wall was registered. The average of pursuit for the series was 10 months, with a maximum of 16 months. The cure of the SUI was obtained in 128 (95%) patients, improvement in 5 (4%) and fails in 2 (1%). Conclusions: TVT-O is a surgical technique for the treatment of the SUI with very promissory results to the present date. Nevertheless, of the same form that the other types of TOT requires a long time to evaluate the real effectiveness

Objetivo: Analizar nuestra experiencia en la aplicación de TVT-O, en la corrección quirúrgica de la incontinencia de orina de esfuerzo (IOE). Pacientes y Método: Seguimiento prospectivo de 135 pacientes sometidos a TVT-O en Clínica Las Condes. Resultados: La mediana de edad fue de 55 años (R: 38 a 74 años), IMC 27,5 (R: 23 a 34) y paridad vaginal 2 (R: 0 a 5). Mediana de tiempo operatorio 7 minutos (R: 4 a 15 minutos). Se presentó una complicación intraoperatoria, correspondiendo al paso de la cinta a través de la uretra. Durante el postoperatorio inmediato se presentaron 7 complicaciones (5%); cinco de ellas fueron sobrecorrección expresada por retención urinaria. En todas se reajustó la cinta por medio de procedimiento ambulatorio a las 48 horas. No hubo hematomas ni infección de la zona operatoria. El alta se dio a las 12 horas en los casos de TVT-O sin asociación a otra cirugía. En el postoperatorio tardío se registró una exposición de la cinta en la pared vaginal anterior. Seguimiento promedio para la serie fue de 10 meses, con un máximo de 16 meses. Se obtuvo la cura de la IOE en 128 pacientes (95%), mejoría en 5 (4%) y falla en 2 (1%). Conclusión: TVT-O es una técnica quirúrgica para el tratamiento de la IOE, con resultados muy promisorios. Sin embargo, de la misma forma que los otros tipos de TOT, requiere una evaluación a largo plazo respecto a su eficacia

OBJECTIVES: We report our experienced with TVT combined with other gynecological procedures, and the complications appeared intraoperative and during the immediate postoperative period. METHODS: Between October 2001 and March 2004 76 patients underwent TVT procedures following the classic technique in the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic. Median age was 53 years old. Urodynamic tests had demonstrated genuine stress urinary incontinence (SUI) (49 cases), intrinsic sphincter deficiency (ISD) (5 cases), and mixed urinary incontinence (MUI) (22 cases). In 61 cases (80.3%) TVT was associated with another gynecological surgery. RESULTS: 82 gynecological operations were associated to TVT. Twenty one patients underwent 2 procedures (34%) and 40 patients one (66%). Laparoscopic surgery 25 cases (41%). Vaginoplasty was the most frequent procedure in 49 cases (80%), laparoscopic hysterectomy 17 (28%), vaginal hysterectomy 5 (8%), laparoscopically assisted vaginal hysterectomy 5 (8%), laparoscopic tubal ligation 3 (5%), Gargiulo operation 1 (2%), annexectomy 1 (2%), and trachelectomy 1 (2%). Intraoperative complications appeared in 4 patients (6.6%). 3 cases of bladderperforation (5%), and 1 case of parietal peritoneumperforation (1.6%). No surgical intervention wasnecessary to solve complications. Two cases of transitory acute urinary retention appeared in the immediate post-operative period. CONCLUSIONS: Our clinical experience demonstrates that the combination of TVT with other gynecological operations in the same procedure is effective and safe. It enables a more comprehensive solution of patient’s problems in the same procedure without increasingmorbidity.

OBJETIVO: Presentamos nuestra experiencia en asociación de TVT a otras cirugías ginecológicas. Y las complicaciones asociadas al acto quirúrgico, y postoperatorio. MÉTODO: Entre octubre 2001 y marzo 2004, se realizó TVT a 76 pacientes con técnica clásica, en la Unidad de Uroginecología y Cirugía Vaginal, de Clínica Las Condes. Mediana de edad 53 años. El test de urodinamia mostró Incontinencia Urinaria de Esfuerzo (IOE) pura (49 casos), con Deficiencia Intrínseca de Esfínter (DIE) (5 casos), e Incontinencia de Orina Mixta (IOM) (22 casos). En 61 (80,3%) se asoció TVT a otra cirugía ginecológica. RESULTADO: Se asociaron 82 cirugías a TVT. Dos cirugías en 21 casos (34%), y una en 40 casos (66%). Cirugía laparoscópica 25 casos (41%). La plastía vaginal fue la más asociada, 49 casos (80%), histerectomía laparoscópica 17 (28%), histerectomía vaginal 5 (8%), histerectomía vaginal asistida laparoscópica 5 (8%), esterilización tubaria laparoscópica 3 (5%), operación de Gargiulo 1 (2%), anexectomía 1 (2%), y traquelectomía 1 (2%). Complicaciones intraoperatorias se presentaron en 4 pacientes (6,6%). Perforación vesical 3 casos (5%), perforación de peritoneo parietal 1 caso (1,6%). Complicaciones asociadas a la inserción de aguja de TVT. No fue necesaria intervención quirúrgica para solucionar las complicaciones. En el postoperatorio inmediato se presentó retención urinaria transitoria en 2 casos. CONCLUSIÓN: Esta experiencia clínica demuestra que el TVT asociado a otras cirugías ginecológicas, durante el mismo acto operatorio, es efectivo y seguro. Permite dar una solución más completa a la paciente, bajo un mismo acto operatorio, y sin aumentar la morbilidad.