ETD

Digital archive of theses discussed at the University of Pisa

 

Thesis etd-05202015-125201


Thesis type
Tesi di specializzazione (5 anni)
Author
GABELLIERI, CRISTINA
URN
etd-05202015-125201
Thesis title
Valutazione funzionale dello sling transotturatorio: ruolo dell'ecografia e della RMN.
Department
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Course of study
UROLOGIA
Supervisors
relatore Prof. Selli, Cesare
correlatore Dott.ssa Pistolesi, Donatella
Keywords
  • incontinenza urinaria
  • porstatectomia
Graduation session start date
03/06/2015
Availability
Full
Summary
Retrourethral transobturator sling is a new functional treatment of stress urinary incontinence after prostatectomy with reported success rate of 54 to 80% and a failure rate of 20 to 45%.
Objective: Aim of the study was to retrospectively analyze morphologic changes visible on MRI and US after sling procedure in continent patients compared with the incontinent ones, in order to detect possible factors explaining the different clinicoutcomes.
Design, Setting, and Participants: 22 male patients treated with the Advance ® sling, were enrolled: 15/22 had clinical recovery, while 7/22 had persistent incontinence. The procedure outcome was defined as cured patients (0 - 1 security pad) or incontinent ones (>2 pads).
The MRI protocol performed with a 3 T system included: 3D T2w sequence (CUBE) and a high temporal resolution Fiesta for dynamic sequence.The US protocol was performed with transresctal and perineal US.
Results were analyzed with t-Student test.
Results and Limitations: In the 8 incontinent patients the length of the urethral bulb posterior to the sling was <8mm while in the continent ones it was >10mm (p<0.0001)both with US and MRI.The sling cold not be directly visualized with MRI while it appeared clearly at US.
Conclusions: The failure of RTS, still poorly understood, can be related to inappropriate indications; based on our results, an incorrect sling placement seems to be another cause of failure. In particular, the length of the urethral bulb posterior to the sling measured with two different imaging tecniques correlates with continence status.
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