26 nov. FEMALE URINARY INCONTINENCE: A DYSFUNCTION WITH MULTIPLE CAUSALITY AND COMPLEX SURGICAL REMEDY
A.Mueller-Funogea*, L.Pirtea**, D. Grigoras**, K.Goeschen***
* EUREGIO – Kontinenz-Zentrum StaedteRegion Aachen, ** UMF Victor Babes Timisoara, Catedra de Obstetrica- Ginecologie, ***Spezialklinik Carpe-Vitam Hannover, Kvinno Germany
Rezumat – Incontinenta urinara feminina: disfunctie cu cauzalitate multipla si remedii chirurgicale complexe
Incontinenţa urinară este o entitate cu etiopatogenie multifactorială, al cărei tratament trebuie individualizat în funcţie de pacient. Acelaşi simptom, pierderea involuntară de urină, poate fi determinat de defecte anatomice diferite, şi prin urmare necesitând abordări chirurgicale diferite. Este prezentat un algoritm de diagnostic şi tratament care are la bază Teoria Integrală a lui Petros. Sunt prezentate 3 cazuri.
Primul caz cu incontinenţă de stress, consecutivă insuficienţei ligamentelor pubouretrale, a fost tratat prin montarea unei bandelete de polipropilena cu pasaj transobturator. Al doilea caz a prezentat incontinenţă prin supraumplere vezicală şi nocturie, având ca defect anatomic un recto- enterocel masiv; tratamentul a constat în ancorarea boltei vaginale folosind sacropexia infracocigeală şi colporafie posterioară, tehnică „bridge”. Al treilea caz prezenta incontinenţă urinară la trecerea din clinostatism în ortostatism, datorită unei zone cicatriciale la nivelul mucoasei vaginale de sub colul vezical; tratamentul a fost excizia ţesutului cicatricial şi acoperirea defectului de mucoasă cu grefa autologă din labia mare, procedeu Martius. Toate cele 3 paciente au reâştigat controlul asupra propriei vezici urinare. Nici o pacientă nu a prezentat hiperreactivitate de detrusor vezical. Toate formele de incontinenţă prezentate au ca punct de pornire un defect anatomic, corectabil chirurgical. Concluzie: pentru a restabili funcţionalitatea planşeului pelvin trebuie reinstaurată anatomia acestuia.
Abstract
The etiologies of female urinary incontinence are diverse and the surgical treatment must be tailored to the specific needs of each patient. Patients sharing the same cardinal symptom, may have different anatomic injuries, and there is need for different surgical approach. Three different cases of urinary incontinence are presented. We used an algorithm of management according to the Integral Theory of Petros. First patient had stress incontinence due to damaged pubourethral ligaments (anatomic deffect), and was treated by transobturator intravaginal sling. Second patient had a massive enterocoele and rectocele due to uterosacral ligaments damage (anatomic deffect), with nocturia (5 micturitions per night), and was treated by infracoccygeal sacropexy and posterior bridge repair. Third patient had „tethered vagina” syndrome, with uncontrolled bladder emptying when standing up, had a imobile bladder neck due to scar tissue on the anterior vaginal wall consecutive to a previous cystocele repair; was treated by restoration of the elasticity in bladder neck area using Martius skin graft. All three patients regained control of their bladder after our surgical treatment. All the urinary incontinence forms described were consecutive to surgical curable anatomical defects. None was due to overactive detrusor activity. Conclusion: in order to restore pelvic floor function, one must restore the anatomy.
Key words: urinary incontinence, Integral Theory of Petros
Keywords: uterin artery embolisation, leiomiome, fibroma, uterus, necrobiosis
