A 53-year-old woman, with no relevant medical or surgical history, presented to our center with moderate stress urinary incontinence (running, running...) of years of evolution, with some voiding at rest and without complaining.
Gynecologic history revealed two previous eutocic births.
No masses or cells were observed in the vaginal discharge, showing significant escape with cough during the examination.
Qtip negative test (20o).
A urodynamic study was performed to assess urinary incontinence (Cistoman and flow pressure study) and urethral profile.
1.
With the diagnosis of sphincter failure by clinic, surgery does not contraindicate reparative incontinence surgery.
Given the clinical (stress urinary incontinence grade III) and anatomical characteristics of the patient, it was decided to place a Remeex type adjustable tension sling without incidents.
A urinary catheter was removed 24 hours after surgery with spontaneous diuresis and no post voiding recurrence.
After 48 hours, the regulation of the system begins; for this purpose, 300 cc of saline are introduced into the bladder and the cough test is performed with a significant negative result, a negative Pad test is performed postmic
Once the therapeutic scheme was established, the system was suspected to be excessively tensioned under the urethra, performing 4 turns of the manipulator anticlockwise and urethral basculation with confirmation of failure.
Finally, two Pad tests with negative results were performed and the manipulator of the stressor was removed and the patient was discharged.
One month after the surgery, the patient came to the consultation complaining of mixed voiding clinical symptoms: thin jet, interlocking, pain due to incomplete exhaustion, abdominal press, polquiuria.
Physical restraint does not show leakage with cough, or presence of fistulas or erosion of the mesh in the vagina.
Urine analysis was performed with negative result and to rule out possible fistula, cystoscopy proving absence of mesh in bladder or urethra or fistula.
The urodynamic study reports bladder outlet obstruction.
1.
With the urodynamic diagnosis of bladder outlet obstruction the manipulator is implanted and 5 loops are distensified in an anticlockwise direction plus posterior urethral basculation under local anesthesia.
Physiological flow is performed in order to check if there is manifestation of the disease.
There were 15 more lapses (for a total of 24 lapses) with subjective improvement of the voiding flow.
A physiological test with Q. plus 22 ml/s with 270 ml of volume, a negative cough test, a negative Pad test and a low postmictional flow were found.
Given the clinical improvement of the patient with disappearance of the escape and absence of postvoid residual, the manipulator is disconnected.
