INFLUENCE OF THE CLINICAL PROFILE OF PATIENTS IN THE NEED FOR PELVIC FLOOR PHYSIOTHERAPY AFTER THE SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE

Barbara-Padilla B1, Hernandez-Sanchez T2, Lopez-Dominguez E3, Lopez-Marcos J3, Marquez-Sanchez M4, Marquez-Sanchez G3, Valverde-Martinez S5, Tinajas-Saldaña A2, Lorenzo-Gomez A6, Miron-Canelo J7, Garcia-Cenador M8, Lorenzo-Gomez M9

Research Type

Pure and Applied Science / Translational

Abstract Category

Rehabilitation

Abstract 576
ePoster 8
Scientific Open Discussion Session 36
On-Demand
Pelvic Floor Rehabilitation Surgery Stress Urinary Incontinence
1. Urology Section of Departament of Surgery of University of Laguna, Tenerife. Spain, 2. Urology Departament University Hospital of Salamanca. Spain, 3. Departament of Surgery of University of Salamanca. Spain, 4. Multidisciplinary Renal Research Group of the Institute for Biomedical Research of Salamanca (IBSAL). Spain, 5. Multidisciplinary Renal Research Group of the Institute for Biomedical Research of Salamanca (IBSAL). Spain. Urology Departament of University Hospital of Avila. Spain, 6. Nursing of Hospital Complex of Zamora. Spain, 7. Multidisciplinary Renal Research Group of the Institute for Biomedical Research of Salamanca (IBSAL). Spain. Departament of Biomedical and Diagnostic Sciences of University of Salamanca. Spain., 8. Departament of Surgery of University of Salamanca. Spain., 9. Urology Departament University Hospital of Salamanca. Spain. Departament of Surgery of University of Salamanca. Spain. Multidisciplinary Renal Research Group of the Institute for Biomedical Research of Salamanca (IBSAL). Spain
Presenter
M

Maria-Fernanda Lorenzo-Gomez

Links

Abstract

Hypothesis / aims of study
INTRODUCTION
Physiotherapy is the first-line treatment for stress urinary incontinence (SUI) and may be necessary after surgical treatment of SUI  (1).  
We try to determine which profile of patients are most likely to need physiotherapy after surgical treatment.

OBJECTIVES: A.-Identify clinical profile of patients who need adjuvant pelvic floor physiotherapy (PT) after stress urinary incontinence (SUI) surgical correction according to the implanted device. B.-Determine factors that influence PT result.
Study design, materials and methods
A retrospective study of 160 women treated with PT after SUI surgical correction. Groups according to technique: GA1 (n = 94): TOT. GA2 (n = 22): REMEEX®. GA3 (n = 44): cystocele plus TOT. Variables: Age, BMI, treatment efficacy, ASA, number of PT sessions, secondary diagnoses, surgical history. Descriptive statistics, ANOVA, Student's t, Fisher's exact test, multivariate analysis, p <0.05 was considered significant.
Results
Average age of 61.63 years (38-92), without differences between groups. BMI there were no differences. Number of sessions: average 17.79 (4-40), lower in partial improvement. In TOT lower number in partial result, but no differences in Remeex or cystocele. More ASA I in GA1 than in GA2, it does not differentiate between GA2 and GA3. More ASA III in cystocele failure. 22.22% of Remeex® success had ASA III versus cystocele success 0% ASA III. More frequent constipation in GA3 (13%) More eutocic deliveries in TOT success (30.36%) than GA3 success, more hysterectomy in GA3 success (34.62%) versus GA1 success. Complete absence of gynecological and obstetric history, 55% of GA1 versus 36% of GA3. Absence of more common toxic habits in GA1 95% versus GA2 81%. Alcoholism is more frequent in GA2 (9%) than in GA1 (0%) Active smoker more frequently in GA2 than in GA1. Having no toxic habit in 92% of cases is more frequent in GA success group compared to GA failure (p = 0.0376).
Interpretation of results
People who undergo surgery for SUI with TOT have a low age since they respond better to treatment. This agrees with the findings of other authors, who state that the failure of long-term treatment with TOT may be advanced age (2).

In our study, patients operated on with Remeex®, who have an older mean age, could be a worse response factor to UI treatment. However, other authors find associated pathology and reoperations in younger women than in our series (3). Women with a lower BMI are more successful in the cystocele. The efficacy of BFB treatment is influenced by the duration of treatment: the greatest number of physiotherapy sessions was performed in the group operated with failure results because they have worse conditions and more sessions are recommended. In our results, patients operated on with Remeex® present a higher ASA. In our setting, we have shown a 68.33% success rate with Remeex® when used in patients with a poor prognosis and previous failures with other techniques (4). 
Women who had a history of cystocele surgery were more related to secondary diagnoses of constipation and digestive dysfunction.
Concluding message
1.- Younger women, with lower ASA and less gynecological-obstetric history than those operated with Remeex® receive adjuvant PT after urinary incontinence surgical correction with TOT or in which the cystocele is corrected while the SUI. 2.-Patients who have adjuvant PT after Remeex® have a same age range, ASA and gynecological-obstetric history, as those who require cystocele correction at the same time as SUI.
References
  1. Chiang H, Valdevenito R, Mercado A. Incontinencia urinaria en el adulto mayor. Revista Médica Clínica Las Condes. 2018)(29):232-41.
  2. Real-Decreto-ley. 1001/2002, de 27 de septiembre, por el que se aprueban los Estatutos Generales del Consejo General de Colegios de Fisioterapeutas. Boletín Oficial del Estado, 27 de septiembre de 2002. . España2002. p. Núm. 242.
  3. Pena Outeirino JM, Rodriguez Perez AJ, Villodres Duarte A, Marmol Navarro S, Lozano Blasco JM. [Treatment of the dysfunction of the pelvic floor]. Actas Urol Esp. 2007;31(7):719-31.
Disclosures
Funding No Clinical Trial No Subjects Human Ethics Committee CEIM. University Hospital of Avila. Helsinki Yes Informed Consent No
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