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CNAA / Theses / 2010 / June /

Treatment of stress urinary incontinence associated with genital prolapse


Author: Feghiu Gheorghe
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2010
Scientific adviser: Valentin Friptu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Adrian Tanase
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 29 June, 2010
Approved by NCAA on the 6 October, 2010

Abstract

Adobe PDF document0.53 Mb / in romanian

Keywords

genital prolapse, stress urinary incontinence, surgical procedure, obstetrical trauma, urethrocystopexy.

Summary

Thesis was elaborated in the Gynecological Department of Medico-Sanitary Public Institution Municipal Clinical Hospital “Sfântul Arhanghel Mihail’’.

Thesis is exposed on 131 pages of typing text, includes 17 tables and 31 figures, comprises introduction and 4 chapters, synthesis of obtained results, conclusion, practical recommendation, has 271 references and 4 annexes. Obtained results are published in 10 scientifical works.

The aim of the study was the elaboration of a surgical procedure regarding restoration of the urinary continence in patients with SUI associated with genital prolapse. Main objectives were: study of the SUI in patients with prolapse; comparative evaluation of the surgical treatment. The study realized during the years 1993-2006 involved 516 patients with genital prolapse. Scientifical innovation and theoretical significance of the study is elaboration of a diagnostic and treatment algorithm for SUI in patients with genital prolapse. Patients with SUI type I (n=141) - surgical treatment by Stoeckel and Kelly techniques. For type II of SUI were utilized: 1) Pereyra technique (1982) – 25 patients, 2) retropubian urethrocystopexy with a flap from vaginal wall (method proposed by he author) – 25 patients and 3) Colpo–or cervicopexy at the aponeurosis of the rectus abdominal muscles (6 patients with prolapse after hysterectomy). In patients with type III of prolapse diverse pubourethral “Sling” methods were utilized with polypropylene mesh (17 cases).Evaluation of the postoperative results 3 years after intervention shows: 1) Stoeckel and Kelly techniques (141 patients) - 77,4 effectiveness; 2) Pereyra technique utilized in 25 patients - 80% cases efficacy; 3) Retropubian urethrocystopexy with flap harvested from vaginal wall (25 patients) - 88% efficacy; 4) Retropubian colpo- or cervicopexy at the abdominal rectus muscle with mesh or polypropylene threads (6 patients) - 83,4% efficacy; 5) procedure like pubourethral “Sling” with polypropylene mesh (17 patients with SUI type III) - 82,4% efficacy.

The research represents a significative applicative value due to its results comparing with other methods of treatment of studied pathology, inclusive that of the Pereyra techniques (1982). Diagnostic algorithm and surgical procedure proposed by the author were implemented in the medical practice of many Medical Sanitary Public Institutions form the Republic of Moldova, thus showing high efficacy, fact that allows recommending it as an elective surgical procedure in the SUI type II treatment associated with voluminous cystocele