Objectives:The sonographic pattern of the mid-urethral sling (MUS) is established in the literature and correlates with symptoms and complications. However, there is a lack of information related to the readjustable sling (RAS) pattern. RAS is a closed system which achieves urethral closure by extrinsic compression of the urethra during Valsalva, and due to its special characteristics is usually reserved for patients with complex stress urinary incontinence (SUI) and hypomobile urethra. We hypothesise that postoperative sonographic parameters of MUS and RAS differ due to different mechanisms of action. Methods: We performed an observational, prospective multicentre study, including women undergoing SUI surgery with transobturator-MUS (TOT-MUS), retropubic-MUS (RT-MUS) and RAS. The primary outcome was comparison of the postsurgical sonographic parameters of RAS with MUS parameters previously described in the literature. The secondary outcomes were: associations between the sonographic parameters of RAS and patients' symptoms, and functional tests and sonographic differences between RAS requiring readjustment. Results: We included 165 patients (55 RAS, 55 TOT-MUS, 55 RT-MUS). RAS was more often located in the proximal urethra and farther from the lumen than MUS, and the dynamic concordant movement was different. Postsurgical Incontinence Questionnaire-Short Form scores were significantly higher in patients with persisting bladder neck funnelling [15.0(3.9) versus 10.6(6.7); p = 0.020] and in those with discordant movement of RAS on Valsalva [14.6(5.7) versus 10.3(6.7); p = 0.045]. Conclusions: In women with complex SUI and hypomobile urethra the postsurgical pelvic floor ultrasound demonstrated that RAS has a different concordant movement on Valsalva compared with MUS and is more often located in the proximal urethra and farther from the urethral lumen at rest. The presence of discordant movement on Valsalva and bladder neck funnelling persistence may be sonographic markers of RAS failure.
La pandemia COVID-19 generó un cambio de forma brusca en la práctica asistencial habitual de nuestra Unidad de Uroginecología, y a raíz de esta situación se ideó un nuevo modelo asistencial para adaptarnos a la nueva etapa epidemiológica. Se acordó, como eje central del nuevo modelo, la disminución de la presencialidad hospitalaria, ofreciendo la misma calidad asistencial mediante la introducción de la telemedicina.Para conseguir tal fin, se elaboró un modelo con tres tipos de visitas nuevas: primera visita médica telemática, visitas de seguimiento de tratamientos conservadores y farmacológicos telemáticas, y creación de visita
pack (pack
STUI, el
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postparto y el
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post-alta) que incluye visitas y pruebas diagnósticas uroginecológicas que se realizan todas el mismo día. El
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STUI va dirigido a todas las pacientes con síntomas del tracto urinario inferior (STUI), asociados o no a prolapso de órganos pélvicos. Consta de dos visitas (enfermería y médica), y dos pruebas diagnósticas avanzadas (urodinamia y ecografía de suelo pélvico).El
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postparto va dirigido a mujeres con síntomas de incontinencia urinaria, incontinencia anal, prolapso y/o alteraciones de la sexualidad tras el parto. También incluye mujeres asintomáticas con antecedente de trauma perineal obstétrico. Consta de una visita médica, una ecografía de suelo pélvico y una visita por la fisioterapeuta.El
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post-alta se realiza al mes de la cirugía e incluye dos pruebas (ecografía de suelo pélvico y flujometría) y una visita médica.Los tratamientos de fisioterapia y otras visitas que por motivos médicos lo requirieran, han mantenido su presencialidad.
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