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Objective: To report short and long-terms results of a prospectiverandomized laparoscopic Burch vs TVT for the treatment ofstress incontinence (GSI).Methods: Since January 1999 to January 2003 we performed 66LB and 67 TVT. In the LB group the mean age was 51years ( range38–65), mean body weight 73 Kg.(range 48–88), mean parity 2,5(range 1–5), menopause 38 (57,5%), while in the TVT group themean age was 53years (range 37–72), mean body weight 70Kg. (range46–84), mean parity 2,3 (range 1–4), menopause 19 (28,3%). All pts.preoperativelly underwent a complete urogynaecological work-up .All the pts. showed S.U.I. mean grade II (according to IngelmanSundeberg) and urethra hypermobile. The surgical precedure wascarried out under epidural anaesthesia for TVT and general for LB.Post menopausal pts were taking systemic or local estrogen therapy.We introduced in the study patients that never underwent a previoussurgery for GSI. The choice of the patients to treat with Burch orTVT was casual. In the study we excluded pts. that needed an additionalsurgical procedure to repair coexisting pelvic floor defects.Results: There were clinical differences between the two methods:procedure time was 1–1,5 h for LB and<30 min for TVT,hospitalization was 2 days and 1 day respectively, anaesthesia wasgeneral for LB and local for TVT, invasiveness mini for LB andmicro for TVT, learning curve: 6 months training for LB and 15days for TVT. Complications: 2 (3,3%) cases of hematoma Retziusin LB and 3 (4,4%) bladder perforations in TVT. Blood loss wasabsent in both methods. The Foley catheter was removed 3–4 hafter procedures in both groups while in the patients with bladderinjuries we put on indwelling catheter for 2 days. At 3 monthsfollow-up all patients were completely dry. At 6–36 months followupin the TVT group 63 (94%) were continent, 3 pts. (4%) weresignificantly improvement, only 1 (1,5%) failed. In the LB group60 (91%) were continent, 2 (3,1%) was significantly improvement,5 pts. (7,5%) failed. In the TVT group we found 3 pts (4,5%) withde novo instability and in the LB group, we found 2 pts (3%) withde novo instability at the post-operative follow-up.Conclusions: The mean hospital cost of TVT is lower than theone of LB. The learning curve for the surgeons is longer for the LB.There is a different cost-effectiveness between the two form ofmanagement: TVT has to be considered more cost-effectivenessthan LB. Anyway the immediate results for both procedures at longfollow-up are encouraging
Lingua originaleEnglish
Numero di pagine0
Stato di pubblicazionePublished - 2003

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