Objective: The aim of this study is to evaluate the safety andefficacy of the Zuidex implacement for the treatment of type IIIincontinence.Methods: We evaluated 36 women (median age 51) with type III( MUCP<20 cm H2O and VLPP<60 cm H2O), with fixed urethrademonstrated (Delta Value<30 at Q-tip test). 21 (58.3%) hadundergone previous continence surgery .They were recluted by acomplete urogynaecological work-up( Vaginal profile, Q- tip test,Endoscopy and Urodynamic study, one hour Pad test, Ultrasonography).We defined as cured patients that were dry after theimplant was performed, and as improved those who decreased innumber of pads and symptoms.We underwent all patients an intraurethralinjection of Zuidex, in four different points at thebladder neck level under local anesthesia. Subjective and urodynamicassessments were made at 6 months after injection toevaluate success and short term effects. No catheter was placedafter procedure and each patient was invited to void spontaneouslyafter four hours before discharge. We introduced the Implacer(with the tube covering the needles) so that the top of the tube islocated approximately at the mid-urethra level. It is important thatthe tube does not move backwards during the insertion into theurethra. To avoid this apply pressure on the rear end of the tubewhile inserting. Pull back the tube to release the needles within theurethra. The position of the needle eyes is then approximately atthe mid-urethra. With a firm grip on the hand piece, retract onesyringe 5–10 mm and then push it forward to its bottom positionSymptom Pre-op (no.) 24 mth post-op (no.)Urge 52 12UI 40 7Constipation 21 2Dyspareunia 20 6Voiding difficulty 32 1S28in order to penetrate the mucosa. Inject the contents of the syringe.Leave the emptied syringe in place. Going clockwise, repeat thismanoeuvre with the remaining 3 syringes. Remove the syringeswith the needles one by one and thereafter the implacer.The syringes,needles and the Implacer must be discarded after the treatmentsession.Results: Objective success rates at six months were 53%(19 pts),significantly improvement 25%(9pts), failures 22%(8 pts). At thefollow-up there was no change in mean bladder capacity, urinaryflow rate, bladder compliance and stability; UPP showed a statisticallysignificant increase in functional urethral length and MPCU.Conclusions: Our clinical studies on use of Zuidex in the endoscopiccorrection of type III incontinence show that up to 78%of patients can be cured or significantly improved. It is easy to useand safe and does not complicate or preclude open surgery at alater date.
|Numero di pagine||0|
|Stato di pubblicazione||Published - 2003|