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Descubrimos la cirugía con bandas transobturadoras

Incontinencia


Bandas transobturadoras
183 42387

Existe un porcentaje de mujeres con escapes involuntarios de orina asociados al esfuerzo que no mejoran fortaleciendo la musculatura del suelo pélvico. A otras se les ha dañado el sostén fascial y la solución es recurrir a una cirugía que restituya el cabestrillo que sostiene la uretra en el ángulo adecuado para garantizar la continencia.


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En estos casos, junto a un debilitamiento de los músculos pubococcígeos que le dan sostén a la vagina puede asociarse la rotura o distensión de los llamados ligamentos pubouretrales que, como su nombre indica, sujetan la uretra en su porción central al borde inferior del pubis garantizando de esta forma el adecuado cierre uretral.

Las llamadas “bandas suburetrales libres de tensión” son mallas de polipropileno a modo de cinta que colocadas vía vaginal han resultado ser la técnica quirúrgica de elección y mínimamente invasiva, para mejorar significativamente e incluso curar la incontinencia urinaria de esfuerzo.

¿En qué consiste la cirugía con banda transobturadora o TOT?

Se trata de una cirugía de corta duración, 15-20 minutos, en posición ginecológica en la mesa de quirófano. Tras una pequeña incisión a 1-2 cm de la uretra se tuneliza un espacio buscando el hueso entre pubis e isquiones, a ese nivel existe un agujero con un músculo: el obturador, y es ahí donde pasamos la cinta mediante agujas helicoidales de forma que queda colocada a modo de hamaca sin tensión por debajo del tramo central de la uretra. El objetivo es sostener la uretra, pero permitir que vaciemos la vejiga sin dificultad al orinar.

En el primer mes tras la cirugía la banda se irá retrayendo e integrando hasta quedar incorporada como sostén de la uretra.

¿De qué material están hechas las bandas?

El polipropileno monofilamento es el material firme pero a la vez suave que proporciona el soporte necesario. Además, es una malla macroporosa, el tamaño de los agujeros de su estructura permite la adecuada integración al tejido corporal reduciendo el riesgo de infección.

¿En qué casos está indicada la cirugía con bandas?

 La afectación de la calidad de vida de la mujer es la que marca la indicación. Es decir, una mujer que practica deporte (carrera, pádel…) y solo tienen perdidas con el impacto del trote o salto, aún estando seca en su vida cotidiana, puede precisar la cirugía con banda porque realmente está afectada su actividad física. Esto indica que no siempre la frecuencia o cuantía de los escapes marcan la indicación quirúrgica. No obstante, la gravedad es determinante, incontinencia urinaria a pequeños esfuerzos y que obligan a cambiar el protector varias veces al día suelen ser más frecuentemente operadas porque el daño anatómico es mayor y los resultados con fisioterapia menores.

¿Es una operación compleja? ¿Qué requisitos son necesarios?

Es una cirugía que puede realizarse en hospital de día pero que exige al menos 3-4 semanas de no cargar peso o realizar actividad física para garantizar el mejor resultado posible.

El principal objetivo es conseguir la mejor continencia urinaria pero sin generar obstrucción, es decir, un cierre excesivo uretral que determinaría dificultad de vaciado al orinar y/o infecciones urinarias. En ese caso habría que seccionar la banda.

También es importante en mujeres con atrofia vaginal por estar en la menopausia el uso de estrógenos locales para prevenir una posible erosión del polipropileno que asomaría por la mucosa vaginal y precisaría curar y resuturar si ocasionase molestias o sangrado en las relaciones sexuales.

Por lo tanto, los beneficios de la cinta transobturadora son indudables, pero siempre evaluando los posibles riesgos y tratándolo con un experto en suelo pélvico.

Fuente: Dra. Gema García Gálvez

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