REPORT OF COMPLICATIONS WITHSUBURETHRAL SLINGS USING INTERNATIONAL UROGYNECOLOGICAL ASSOCIATIONAND INTERNATIONAL CONTINENCE SOCIETY (IUGA/ICS) CLASSIFICATION SCALE.10 YEARS OF EXPERIENCE IN A UNIVERSITY HOSPITAL.
C. A. DIAZ1, C.BELTRAN 2, G. A. PARRA 3;
1Urogynecology& pelvic floor Unit of Hospital de San Jose, Fndn. Univ. ofHlth.Sci. ( FUCS), Bogota, Colombia, 2Hosp. de San Jose,Bogota, Colombia, 3SES Hospital de Caldas, Ginecology andobstetrics unit. Manizales, Caldas., Fndn. Univ. of Hlth.Sci. (FUCS), Bogota, Colombia.
Introduction: The use ofprosthetic slings has increased considerably in the urogynecologicalsurgeries, this increasing the number of possible complicationsassociated with their use. In order to unify the criteria forreporting complications related to the placement of suburethralprosthesis in surgery of the pelvic floor, the IUGA / ICS., addressedthe issue and designed a standard classification of terminology, based on three criteria: category (C), time (T) and site (S), thisclassification summarizes a wide range of possible clinicalscenarios. The symptoms and findings are expressed in a CTS code. TheC identifies exposure and related complications Biointegrity ofprosthetic material, if there was injury to the urinary tract,gastrointestinal and patient engagement. T the time of appearance ofthis and the S the site where it occurred in relation to the graft,which can help facilitate the implementation of a more uniform andreliable complications in surgery of the pelvic floor.
Objective:few studies used the classification IUGA / ICS for reportingcomplications with sub urethral slings (SUS). We want to contributeto their development using this in urinary incontinence surgery. 10years of experience in a university hospital.
Methods: adescriptive, retrospective, continuous study was conducted. Wereviewed the medical records of patients who got SUS: Obturator(TVT-O), retropubic (TVT-R), or handcraft sling (HCS), from 2004 to2015. We applied the IUGA/ICS scale for complications. Similarstudies in the literature where reviewed and compared withours.
Results: 385 patients were included, TVT-O: 282(72.68%), TVT-R: 80 (20.84%) and HCS: 23 (6.48%). Complications:TVT-O: 19.5% (55/282), TVT-R: 40% (32/80), HCS 56.5% (13/23).Exposure rate: TVT-O: 2.48% (7/282), TVT-R: 1.2% (1/80), HCS 4.3%(1/23). Compromise of urinary tract: TVT-O: 8.5% (24/282), TVT-R:31.2% (25/80), HCS: 30.4% (7/23). Being the 4B 6.38% (18/282); 17%(14/80); 26% (6/23) respectively. Skin or general compromise was lessthan 2% for all the 3 slings. The biointegration of the SUS accordingwith published literature and our study using this classificationwould be: exposure between (2.6-7.6%) and palpation that generatesdiscomfort (1.9-6.4%)
Conclusions: Coinciding with theliterature we found that the largest number of complications wascategory 4B, followed by 4A. We suggest as others, to recategorizethe classification to better study subgroups and better target itshandling. The alterations during the biointegration using this scalefor SUS would be between 4.5-14% that we must take in account when weplan to use them.
References: 1. Int UrogynecolJ.2010;22(1):3-15. 2 Int Urogynecol J.2011;22(11):1429-35. 3. Eur JObstet Gynecol Reprod Biol.2012; 165(2):347-51. 4. Int UrogynecolJ.2015;27(6):933-38.