Single incision vs TOT

Single incision vs

MAURIZIO SERATIRicercatore Universitario - Clinica Ostetrica e Ginecologica

Università degli Studi dell’Insubria - Varese

TOT

Invasiveness Complication rateClinical cure

WHAT IS THE GOLD-STANDARD?

It’s better to be tormented by

doubts, rather than run the risk of living

with the wrong conviction

Why

?

http://www.google.it/url?sa=i&rct=j&q=il+cambiamento&source=images&cd=&cad=rja&docid=1ZWFXDLldxIUPM&tbnid=IN-1TqFy403WrM:&ved=0CAUQjRw&url=http://www.organizzazioneventi.org/news/?newsId=28&ei=Kr0PUfbTC6O40QW_0oDICA&bvm=bv.41867550,d.Yms&psig=AFQjCNFsYN8S0NrEI-K5ItKi88jOI4Iong&ust=1360072251554288

http://www.google.it/url?sa=i&rct=j&q=why+change&source=images&cd=&cad=rja&docid=quA3-zQl0IF4vM&tbnid=z-FtpMgEUA47TM:&ved=0CAUQjRw&url=http://21stcenturylearning.typepad.com/blog/2009/01/why-change.html&ei=FsAPUfuVN5Gb1AWA4IGABw&bvm=bv.41867550,d.Yms&psig=AFQjCNHL-i1U52IwZavD-s_VhS9mB4VJlA&ust=1360073049324659

TVT

http://www.google.it/url?sa=i&rct=j&q=tvt+sling&source=images&cd=&cad=rja&docid=2DmYtLlSdRGNzM&tbnid=TGzp4X94VR-O6M:&ved=0CAUQjRw&url=http://www.sjhsys.org/offices/urology/education.php?id=71&ei=F6oPUePqOciRswa6uIHQDg&bvm=bv.41867550,d.bGE&psig=AFQjCNEgsEi4mU0Hq3xGOCnqpkaGklsZjg&ust=1360067382650094

APPROCCIO TRANSOTTURATORIO

http://www.google.it/url?sa=i&rct=j&q=BERSAGLIO+CLIPART+VIDEO&source=images&cd=&cad=rja&docid=F-E_z5M3XN7mxM&tbnid=dujR3fHXBH9TnM:&ved=0CAUQjRw&url=http://www.123rf.com/photo_6744959_bersaglio-colpito-al-centro-da-una-freccia.html&ei=SjEQUbyPDo35sgbW-IDgCw&bvm=bv.41867550,d.Yms&psig=AFQjCNFvLtVbn107WcHXvXKxPS8SehLy0A&ust=1360101899489008

The pain experienced by the transobturatorroute may be reduced using newer products that aim to shorten the length of the tape and avoid mesh penetratingthe adductor muscles of the thigh

SINGLE INCISION

http://www.google.it/url?sa=i&rct=j&q=tvt+abbrevo+gynecare&source=images&cd=&cad=rja&docid=QQeQ1H4ElfY7IM&tbnid=h7xz2sNsn2-pZM:&ved=0CAUQjRw&url=http://silvestreart.com/wiigame.html&ei=DCAVUaqUH4zdsgbbnIHgBw&bvm=bv.42080656,d.Yms&psig=AFQjCNEliuCEAXTmxuv-S-DfQSoRV5uuHw&ust=1360425341566059

APPROCCIO TRANSOTTURATORIO

TVT Single incision

TVT-O

RETROPUBIC VS

TRANSOBTURATOR ?

TO-MUS VS RP-MUS

vs

N Engl J Med 2010

Retropubic vs Transobturator

N Engl J Med 2010

Retropubic vs Transobturator

RETROPUBIC VS

TRANSOBTURATOR ?

TO-MUS VS RP-MUS

TRANSOBTURATOR

TO-MUS VS RP-MUS

E allora perché le single incision?

Discontent is the first step towards

progress

Ma quali sarebbero i

motivi di «discontent

»?

PAIN

Tape types: which is the most painful tape?

http://www.google.it/url?sa=i&rct=j&q=dolore+gif&source=images&cd=&cad=rja&docid=8Re367ZrKXTY4M&tbnid=yuShoKTKsU5_wM:&ved=0CAUQjRw&url=http://www.uffa.it/foto-divertenti/foto-scattata-un-attimo-prima-un-dolore-tremendo&ei=2hMVUcyAF4yFhQew6oGgAg&bvm=bv.42080656,d.Yms&psig=AFQjCNHIOKC_DFaIcNq8pQZVm052MMWvEw&ust=1360422228807218

vs

PAIN

http://www.google.it/url?sa=i&rct=j&q=tvt+sling&source=images&cd=&cad=rja&docid=2DmYtLlSdRGNzM&tbnid=TGzp4X94VR-O6M:&ved=0CAUQjRw&url=http://www.sjhsys.org/offices/urology/education.php?id=71&ei=F6oPUePqOciRswa6uIHQDg&bvm=bv.41867550,d.bGE&psig=AFQjCNEgsEi4mU0Hq3xGOCnqpkaGklsZjg&ust=1360067382650094

http://www.google.it/url?sa=i&rct=j&q=ahiahi&source=images&cd=&cad=rja&docid=ff_PuDKRs0EylM&tbnid=vqC5LJ_aT8nWnM:&ved=0CAUQjRw&url=http://massimocavezzali.blogspot.com/2011/03/cavezzali-ahi-ahi-ahi-ahi.html&ei=fxsVUbKZIseP0AX13oHYDQ&psig=AFQjCNGlTNcd7PnU7JuZMlmaOskhFFAheQ&ust=1360423951067471

The pain experienced by the transobturatorroute may be reduced using newer products that aim to shorten the length of the tape and avoid mesh penetratingthe adductor muscles of the thigh

PAIN

1°-2°day 1° month

PAIN

http://www.google.it/url?sa=i&rct=j&q=emoticon&source=images&cd=&cad=rja&docid=Fs5vzTC-q7DjDM&tbnid=LvGTlU7FPxbNtM:&ved=0CAUQjRw&url=http://it.dreamstime.com/immagine-stock-fronti-del-emoticon-image5927431&ei=vyEVUfzEFYvKsgb59YDgAw&bvm=bv.42080656,d.Yms&psig=AFQjCNFHmGGmIseEqY-x-8oxkQ1e8fbrGA&ust=1360425732762353





Subj

ectiv

e cu

re ra

te

• A trend towards higher rates of repeat continence surgery was noted in the SIMS group

• No studies on the SIMS with medium- or long-term follow.up exist

• Abdel-Fattah failed to demonstrate that the SIMS is associated with a lower complication rate in terms of voiding dysfunction, de novo OAB, vaginal erosion, or lower urinary tract injuries

SINGLE INCISION VS TRANSOBTURATOR

E’ TUTTO COSÌ COMPLESSO

SINGLE INCISION VS TRANSOBTURATOR2014

Monarc MiniArc

vs

E’ lo studio che riporta la più grande differenza in termini di dolore…

…MA…

perché SEMPRE OUT IN?

CLINICAMENTE PIU’ RILEVANTE DOLORE O DISAGIO PER VOIDING DYSFUNCTION?

OBSTET GYNECOL: ANCORA Più DUBBIO CLINICAMENTE RILEVANTE, NEMMENO

DIFFERENZA DI ANALGESICI

INSIDE-OUT VS OUTSIDE-IN?

Ma la TO causa davvero sempre

così tanto dolore?

p = 0.01

…CONCLUDENDO…



PARI EFFICACIA?


MINOR DOLORE?

NESSUNA CERTEZZA…NULLA DI PARAGONABILE A RP VS TO


NON SEMPRE CIO’ CHE VIEN

DOPO E’ PROGRESSO

A volte è meglio tacere e sembrare stupidi che aprire bocca e togliere ogni dubbioO.Wilde

Lago di Varese

Single incision vs TOT

Health & Medicine

Transcript of Single incision vs TOT