[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].
OBJECTIVE
The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access.


METHODS
The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995.


RESULTS
16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients.


CONCLUSIONS
Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.
Marqués Queimadelos
A
A
Complexo Hospitalario Universitario de Santiago de Compostela, España. amarquesq@meditex.es
Abascal García
R
R
Muruamendiaraz Fernández
V
V
Virseda Rodríguez
J
J
Arañó Bertran
P
P
Fernández Fernández
E
E
Sousa Escandón
A
A
Cimadevila García
A
A
Cimadevila Covelo
A
A
Rios Tallón
Y L
YL
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation; D012008:Recurrence; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014549:Urinary Incontinence / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D014563:Urodynamics; D014621:Vagina / Q000601:surgery
Implantación del esfínter urinario artificial en la mujer con incontinencia urinaria por vía combinada abdomino vaginal.