Study design, materials and methods
Descriptive retrospective study. The database of patients who had surgery by the pelvic floor unit between 2014 and 2018 in a teaching hospital was analyzed. All patients who underwent a retropubic sling alone or in conjunction with other surgery were included. The variables studied were age, parity, associated diseases, sexual activity, type of incontinence, pelvic organ prolapse, intraoperative complications and surgical time. Patients with most inconclusive data were excluded. Univariate analysis was performed using absolute and relative frequencies.
280 patients underwent surgery during the study period. The average age was 52 years (SD 8.12 range 26-83). The parity was 3.07 (SD 1.48). 65.11% had a diagnosis of an associated disease. 82.45% reported being sexually active. 62.7% had a diagnosis of stress urinary incontinence and 37.3% had a diagnosis of mixed urinary incontinence with predominance of stress. 65.04% had a diagnosis of stage I or greater pelvic organ prolapse. 42.86% were accompanied by associated surgeries, the most frequent being pelvic organ prolapse surgery, with 72.5% of all complementary surgeries and 13.3% hysterectomy. There were 24 patients who had intraoperative complications corresponding to 8.57%. The most common complication was bladder perforation, accounting for 7.14% of the total, with 0.7% being bilateral perforation. Only one serious complication was described, the generation of a massive retropubic hematoma, corresponding to 0.35%. There were no deaths associated with the procedure. The average surgical time was 43.8 minutes with a minimum of 15 minutes to a maximum of 250 minutes, including associated surgeries.
Interpretation of results
The characteristics of the group studied, such as age, parity and associated diseases, correspond to most groups of patients with stress or mixed urinary incontinence, as well as the presence of pelvic organ prolapse. However, despite the high percentage of patients with pelvic organ prolapse diagnosed at physical examination, not all of them correspond to symptomatology, which can explain the difference between the percentage of women with prolapse diagnosis and those who required pelvic organ prolapse correction surgery. Nevertheless, pelvic organ prolapse correction surgery was the most common in association, followed by vaginal or abdominal hysterectomy for benign causes. Although the percentage of complications is close to some reports, it is rather high than most studies. This would be explained by the fact that the hospital where the study was performed is a teaching hospital, and the retropubic tape is mostly performed by gynecologists in training. Even so, most of these complications are bladder perforation, which has no sequelae. The percentage of major complications does correspond with international reports, which reflects the safety of the procedure. As for the surgical time, it is difficult to conclude anything, considering that many of these interventions were part of a more complex surgery. Although intraoperative complications are minor, it is essential to implement mitigation strategies to reduce them. One of these strategies would be the incorporation of simulation prior to the confrontation of real patients. A strength of this work is the number of the cohort. Among its weaknesses, the lack of determination of the type of surgeon leads us to infer with respect to our reality. It is also necessary to see the evolution of our patients. A longer-term follow-up is required to determine the objective and subjective results of this intervention.