single incision vs tot
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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
?
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
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
N Engl J Med 2010
Retropubic vs Transobturator
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?
vs
PAIN
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
2014
Subj
ectiv
e cu
re ra
te
QOL
• 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
2014
SINGLE INCISION VS TRANSOBTURATOR
2014
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?
2014
2015
SINGLE INCISION VS TRANSOBTURATOR
Ma la TO causa davvero sempre
così tanto dolore?
2015
p = 0.01
…CONCLUDENDO…
SINGLE INCISION VS TRANSOBTURATOR
SINGLE INCISION VS TRANSOBTURATOR
PARI EFFICACIA?
SINGLE INCISION VS TRANSOBTURATOR
PARI EFFICACIA?
SINGLE INCISION VS TRANSOBTURATOR
PARI EFFICACIA?
SINGLE INCISION VS TRANSOBTURATOR
MINOR DOLORE?
SINGLE INCISION VS TRANSOBTURATOR
MINOR DOLORE?
NESSUNA CERTEZZA…NULLA DI PARAGONABILE A RP VS TO
SINGLE INCISION VS TRANSOBTURATOR
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
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