urodinamica prima della chirurgia per prolasso
TRANSCRIPT
MAURIZIO SERATI Clinica Ostetrica e GinecologicaUniversità degli Studi dell’Insubria - Varese
URODINAMICA PRIMA DELLA CHIRURGIA
PER PROLASSO
CONTRO
PERCHE’ PROPRIO IO?
PERCHE’ PROPRIO IO?
It’s better to be tormented by
doubts, rather than run the risk of living
with the wrong conviction
PERCHE’ PROPRIO IO?
PROLASSO GENITALE
Urodinamica
Prolasso genitaleUrodinamica
CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING
DYSFUNCTION
Quando farla prima della chirurgia del prolasso?
Urodinamica
Quando farla prima della chirurgia del prolasso?
Urodinamica
CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING
DYSFUNCTION
Urodinamica CONCOMITANTE SUI
Diagnosi Terapia
Urodinamica CONCOMITANTE SUI
Manifesta Occulta
Urodinamica CONCOMITANTE SUI
Urodinamica: USI
2000
342 euro
Urodinamica: USIOPUS trial 2012
Urodinamica: USI
OPUS trial 2012
Urodinamica: USI
The authors estimated that in asymptomatic female
population, at 12 months, 6.3 prophylactic slings
would have to be inserted to prevent one woman from becoming stress
incontinent after prolapse repair.
Urodinamica: USI
Urodinamica: USI
CONCLUSIONS
Urodinamica: USIOPUS trial 2012
The authors who are in favour of urodynamics in women with POP, often claim that this evaluation, in women without symptoms of SUI, enables the demonstration of occult stress incontinence (OSI) and possibly its treatment. However, this has not been well-demonstrated and, moreover, the best way to unmask the OSI during urodynamics, is not standardised and universally accepted.
Urodinamica
2007OSI is diagnosed in about 50% of the patients
with genital prolapse not reporting stress incontinence before surgery
Urodinamica
2007
Urodinamica: USI
Urodinamica: USI
Urodinamica: USI
Urodinamica: USI
Urodinamica: USI
It seems evident that even if urodynamics could diagnose OSI, using validated and standardised
methods (which is not true at the time), there would be no scientific evidence that it is always appropriate
and convenient to associate the two surgical
procedures. Therefore, the urodynamics diagnosis would still not be able to change with absolute certainty the
surgical choice
Quando farla prima della chirurgia del prolasso?
Urodinamica
CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING
DYSFUNCTION
Urodinamica: OAB
…Another argument put forward by supporters UDS is that these tests could predict the persistence of symptoms of overactive bladder… However, a significantly reduced cure rate with antimuscarinics in women with OAB and concomitant anterior vaginal wall descent has been demonstrated
Urodinamica: OABJ Urol. 2001 Dec;166(6):2263-6.
Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse.Nguyen JK, Bhatia NN
…women with POP and concomitant symptomatic detrusor overactivity (DO) there is resolution of DO in approximately two-thirds of women after prolapse repair
Quando farla prima della chirurgia del prolasso?
Urodinamica
CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING
DYSFUNCTION
Urodinamica: voiding dysfunction
Urodinamica: voiding dysfunction
Urodinamica: voiding dysfunction
Urodinamica: voiding dysfunction
Urodinamica: voiding dysfunction
Urodinamica: voiding dysfunction
…CONCLUDENDO…
Urodinamica
Urodinamica
OAB OSI
…but these informations rarely could change the management plan or the type of surgical procedure…
Urodinamica
Urodinamica
Non ancora chiaro il suo ruolo nel management preoperatorio delle donne con prolasso ±
incontinenza urinaria da sforzo
Prolasso genitaleUrodinamica
Sacro Monte di Varese