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Calidad de vida en pacientes intervenidas quirúrgicamente mediante malla transobturadora para la corrección de incontinencia urinaria de esfuerzo
Quality of life following transobturator sling surgery for female stress urinary incontinence
C. Gómez Fernándeza, A. Otero Naveirob,
Autor para correspondencia
anaonaveiro@gmail.com

Autor para correspondencia.
, A. Raña Mayánc, M. Pérez Lópezb, P. Martínez Lópezb, E. Paz Fernándezb
a King's College Hospital NHS, Londres, Reino Unido
b Hospital Universitario Lucus Augusti, Lugo, España
c Hospital HM Montepríncipe, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aunque la incontinencia urinaria &#40;IU&#41; es un problema frecuente que afecta a millones de personas&#44; un alto porcentaje de quienes la padecen no acude a consulta debido a la creencia generalizada de que es un proceso natural asociado al envejecimiento&#46; Seg&#250;n los datos m&#225;s recientes&#44; la IU es una de las enfermedades cr&#243;nicas m&#225;s comunes&#44; afectando al 17-60&#37; de las mujeres<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La IU se define como la p&#233;rdida involuntaria de orina a trav&#233;s de la uretra&#46; El tipo m&#225;s com&#250;n de IU es la incontinencia urinaria de esfuerzo &#40;IUE&#41;&#44; que representa hasta el 50&#37; de todos los casos de incontinencia entre las mujeres y suele estar inducida por actividades que provocan un aumento repentino de la presi&#243;n intraabdominal&#44; como estornudar o re&#237;r<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a>&#46; La etiolog&#237;a de esta forma de incontinencia en la mujer se ha atribuido a factores como la edad&#44; la menopausia o la obesidad<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a>&#44; aunque otras posibles causas son las enfermedades neurol&#243;gicas&#44; los trastornos metab&#243;licos&#44; la ingesta de diur&#233;ticos&#44; la cirug&#237;a p&#233;lvica y las situaciones que provocan un aumento cr&#243;nico de la presi&#243;n intraabdominal&#44; como la obesidad<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Entre las t&#233;cnicas m&#225;s utilizadas para tratar la IUE se encuentran las t&#233;cnicas de banda vaginal libre de tensi&#243;n con abordaje retrop&#250;bico &#40;TVT&#41; y abordaje transobturador &#40;fuera-dentro &#91;TOT&#93; o dentro-fuera &#91;TVT-O&#93;&#41;&#46; Aunque ambos m&#233;todos han presentado resultados similares&#44; el cabestrillo transobturador se ha asociado a tasas menores de complicaciones y a una duraci&#243;n m&#225;s corta de la intervenci&#243;n quir&#250;rgica y de la estancia hospitalaria<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a>&#46; Sin embargo&#44; el impacto de los factores predisponentes de la IUE sobre el &#233;xito del tratamiento con cabestrillo han sido poco estudiados<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las p&#233;rdidas de orina empeoran considerablemente la calidad de vida&#44; afectando tanto el bienestar f&#237;sico como el mental&#46; El impacto de la incontinencia en la calidad de vida depende en gran medida de la gravedad de los s&#237;ntomas<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de nuestro estudio fue evaluar la calidad de vida preoperatoria&#44; postoperatoria y a los 5 a&#241;os de la intervenci&#243;n en mujeres sometidas a la colocaci&#243;n de cabestrillo transobturador para el tratamiento de la IUE&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio de cohortes retrospectivo incluyendo a todas las mujeres sometidas consecutivamente a cirug&#237;a con cabestrillo transobturador para el tratamiento de la IUE en un centro terciario &#40;Hospital Universitario Lucus Augusti&#44; Lugo&#44; Espa&#241;a&#41; en los a&#241;os 2014 y 2015&#46; Todas las intervenciones fueron realizadas por el mismo equipo quir&#250;rgico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La variable de resultado principal fue la calidad de vida determinada en el preoperatorio y en 2 visitas de seguimiento&#58; la primera se program&#243; aproximadamente a los 6 meses de la cirug&#237;a y la segunda se realiz&#243; al menos 5 a&#241;os despu&#233;s&#44; en 2020&#46; Esta variable de resultado se evalu&#243; mediante cuestionarios utilizados habitualmente en la pr&#225;ctica cl&#237;nica para identificar el tipo de IU que padece una persona y su repercusi&#243;n en la calidad de vida&#58; el test de severidad de Sandvick y el cuestionario breve de calidad de vida International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form &#40;ICIQ-UI-SF&#41;&#46; El test de severidad de Sandvick eval&#250;a la frecuencia y la cantidad de las p&#233;rdidas de orina&#44; y su resultado es la puntuaci&#243;n que se obtiene multiplicando los resultados de ambas preguntas&#46; Con base en esta herramienta&#44; el deterioro de la calidad de vida se defini&#243; como leve &#40;1-2 puntos&#41;&#44; moderado &#40;3-6 puntos&#41;&#44; grave &#40;8-9 puntos&#41; o muy grave &#40;12&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a>&#46; El cuestionario ICIQ-UI-SF consta de 3 &#237;tems &#40;frecuencia&#44; cantidad e impacto&#41; y 8 preguntas relacionadas con los s&#237;ntomas para guiar el diagn&#243;stico del tipo de IU&#46; Las respuestas a estas &#250;ltimas preguntas no se tienen en cuenta en la puntuaci&#243;n final&#44; pero proporcionan informaci&#243;n sobre las circunstancias que pueden causar la IU&#46; En consecuencia&#44; para cada paciente&#44; la puntuaci&#243;n final de 0 a 21 se calcul&#243; como la suma de las puntuaciones obtenidas en los 3 primeros &#237;tems<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Otras variables de resultado consideradas fueron las complicaciones intraoperatorias &#40;hemorragia y&#47;o lesi&#243;n vesical&#44; uretral o vascular&#41;&#44; las complicaciones postoperatorias &#40;infecci&#243;n&#44; retenci&#243;n urinaria&#44; entre otras&#41; y el fracaso del tratamiento &#40;IUE persistente&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables independientes recogidas fueron edad&#44; peso&#44; altura&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; h&#225;bito tab&#225;quico&#44; ocupaci&#243;n &#40;carga de trabajo y&#47;o ejercicio f&#237;sico&#41;&#44; comorbilidades &#40;diabetes mellitus y enfermedad neurol&#243;gica&#41;&#44; antecedentes de cirug&#237;a ginecol&#243;gica previa&#44; f&#243;rmula obst&#233;trica&#44; menopausia&#44; localizaci&#243;n y grado de prolapso de &#243;rganos p&#233;lvicos&#44; resultados de la prueba de esfuerzo y del estudio urodin&#225;mico&#44; y complicaciones precoces &#40;extrusi&#243;n de la malla&#44; tenesmo <span class="elsevierStyleItalic">de novo</span>&#44; dolor p&#233;lvico&#44; dispareunia&#44; infecci&#243;n urinaria&#44; entre otras&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El test de esfuerzo se realiz&#243; en dec&#250;bito supino con control ecogr&#225;fico durante el llenado vesical y pidiendo a las pacientes que tosieran para inducir la p&#233;rdida&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El sobrepeso y la obesidad se identificaron mediante el IMC<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a>&#46; La cohorte se dividi&#243; en 3 grupos para determinar el impacto del IMC en los resultados del tratamiento&#58; peso normal &#40;18&#44;5-24&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; sobrepeso &#40;25-29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41; y obesidad &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Todos los datos se obtuvieron a partir de las historias cl&#237;nicas electr&#243;nicas de las pacientes con su consentimiento informado previo&#46; El estudio se realiz&#243; de acuerdo con la Declaraci&#243;n de Helsinki&#44; y el protocolo fue aprobado por el Comit&#233; de &#201;tica de Santiago-Lugo el 13 de junio de 2020 &#40;c&#243;digo de registro&#58; 158 2020&#47;146&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Las variables cualitativas se presentan como distribuciones de frecuencias y las cuantitativas como media y desviaci&#243;n est&#225;ndar &#40;DE&#41;&#44; o mediana y rango intercuart&#237;lico &#40;RIQ&#41; cuando no hab&#237;a una distribuci&#243;n normal&#46; Las variables cualitativas se compararon mediante la prueba chi-cuadrado y las variables cuantitativas mediante la prueba t de Student para muestras independientes o la prueba U de Mann-Whitney para datos con distribuci&#243;n no normal&#46; Las variables de resultado primarias se analizaron mediante la prueba t de Student para datos emparejados y el efecto medio absoluto se presenta con su intervalo de confianza del 95&#37; &#40;IC 95&#37;&#41;&#46; Se construy&#243; un modelo de regresi&#243;n log&#237;stica binaria para identificar los factores asociados al fracaso del tratamiento incluyendo las variables cl&#237;nicamente relevantes&#46; Todas las pruebas estad&#237;sticas se realizaron con el programa STATA v&#46; 15&#46;0&#46; La significaci&#243;n se fij&#243; en p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">La poblaci&#243;n de estudio constaba de 51 mujeres diagnosticadas de IUE sometidas a cirug&#237;a con t&#233;cnica transobturadora &#40;TOT&#47;TVT-O&#41; en los a&#241;os 2014 y 2015 en nuestro centro&#46; Las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de las pacientes incluidas se recogen en las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#46; Las participantes ten&#237;an una edad media de 62 a&#241;os &#40;DE 10&#44; RIQ 54-70&#41;&#46; El 74&#44;5&#37; &#40;38&#47;51&#41; fueron operadas en 2014 y el 25&#44;5&#37; &#40;13&#47;51&#41; en 2015&#46; Del total de la cohorte&#44; el 78&#37; &#40;39&#47;50&#41; hab&#237;a tenido al menos 2 embarazos&#44; y se registr&#243; al menos un parto vaginal en 46 mujeres &#40;92&#37;&#44; 46&#47;50&#41;&#46; El 88&#44;2&#37; &#40;45&#47;51&#41; de las mujeres estaban en la menopausia en el momento del tratamiento quir&#250;rgico&#46; El IMC medio era de 28&#44;96<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;DE 4&#44;84&#59; RIQ 25&#44;64-31&#44;53&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Los resultados de la exploraci&#243;n preoperatoria&#44; el diagn&#243;stico de IUE&#44; el tipo de intervenci&#243;n y las complicaciones intra&#47;postoperatorias se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Al inicio del estudio &#40;preoperatorio&#41;&#44; el 91&#44;3&#37; &#40;42&#47;46&#41; de las participantes presentaron una prueba de esfuerzo positiva&#46; El estudio urodin&#225;mico revel&#243; IUE aislada en el 97&#44;8&#37; &#40;45&#47;46&#41; de las pacientes&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">El 54&#44;9&#37; &#40;28&#47;51&#41; de nuestras pacientes se sometieron a la colocaci&#243;n de una malla transobturadora&#44; mientras que el resto de las mujeres &#40;45&#44;1&#37;&#44; 23&#47;51&#41; se sometieron a la colocaci&#243;n de una malla transobturadora y a otro tipo de intervenci&#243;n&#44; como la cirug&#237;a del prolapso&#44; simult&#225;neamente&#46; En el 72&#44;5&#37; &#40;37&#47;51&#41; de las mujeres&#44; el abordaje transobturador se realiz&#243; con la t&#233;cnica TOT &#40;fuera-dentro&#41;&#44; mientras que en el 27&#44;5&#37; &#40;14&#47;51&#41; se utiliz&#243; la t&#233;cnica TVT-O &#40;dentro-fuera&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las complicaciones intraoperatorias m&#225;s frecuentes registradas fueron la perforaci&#243;n vaginal en 4 mujeres &#40;7&#44;8&#37;&#44; 4&#47;51&#41;&#44; 3 de las cuales se sometieron a cirug&#237;a con t&#233;cnica de banda transobturadora de incisi&#243;n &#250;nica y una tambi&#233;n a cirug&#237;a de prolapso&#46; La complicaci&#243;n postoperatoria m&#225;s frecuente fue la retenci&#243;n urinaria&#44; que se registr&#243; en una paciente &#40;2&#37;&#44; 1&#47;51&#41; sometida tanto a t&#233;cnica de malla transobturadora como a correcci&#243;n del prolapso&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> incluye las variables cualitativas que se recogieron en la primera visita postoperatoria&#46; Las tasas de extrusi&#243;n de la malla y de fracaso de la t&#233;cnica fueron del 4 &#40;2&#47;50&#41; y 12&#37; &#40;6&#47;50&#41;&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se obtuvieron los datos completos de seguimiento a 5 a&#241;os de 35 pacientes&#46; El impacto del tratamiento sobre la calidad de vida evaluada mediante el cuestionario ICIQ-UI-SF &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41; supuso una reducci&#243;n absoluta de la puntuaci&#243;n media de 9&#44;47 &#40;IC 95&#37;&#58; 6&#44;93-12&#44;02&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en la primera visita de seguimiento&#44; y de 8&#44;78 &#40;IC 95&#37;&#58; 6&#44;43-11&#44;14&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; a los 5 a&#241;os de la intervenci&#243;n&#44; en comparaci&#243;n con la puntuaci&#243;n basal&#46; Los efectos del tratamiento con cabestrillo sobre la frecuencia y severidad de las p&#233;rdidas de orina presentaron una reducci&#243;n absoluta de 5&#44;46 &#40;IC 95&#37;&#58; 4&#44;17-6&#44;74&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y 4&#44;54 &#40;IC 95&#37;&#58; 3&#44;25-5&#44;83&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en la prueba de gravedad de Sandvick de la primera visita y a los 5 a&#241;os de seguimiento&#44; respectivamente&#44; en comparaci&#243;n con la puntuaci&#243;n basal&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En el modelo de regresi&#243;n log&#237;stica construido para evaluar los factores asociados al fracaso terap&#233;utico en la primera visita postoperatoria &#40;en torno a los 6 meses&#41;&#44; se incluyeron la edad&#44; el IMC&#44; la multiparidad y los antecedentes de cirug&#237;a ginecol&#243;gica previa como posibles factores predisponentes&#46; Los factores independientes que mostraron relaci&#243;n con el fracaso del tratamiento fueron la multiparidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y la cirug&#237;a ginecol&#243;gica previa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41;&#46; Cuando se compararon los efectos del abordaje quir&#250;rgico &#40;dentro-fuera vs&#46; fuera-dentro&#41; en la calidad de vida&#44; no se detectaron diferencias significativas entre los 2 grupos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Para examinar los efectos de la obesidad sobre los resultados obtenidos&#44; se compararon las mejoras en la puntuaci&#243;n de la calidad de vida seg&#250;n los grupos de IMC&#46; Este an&#225;lisis indic&#243; que las mujeres con obesidad mostraban una disminuci&#243;n menos significativa de la puntuaci&#243;n a lo largo del tiempo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">En esta cohorte de mujeres con IUE sometidas a cirug&#237;a con cabestrillo transobturador&#44; se obtuvo una reducci&#243;n significativa de las puntuaciones de calidad de vida a los 5 a&#241;os del tratamiento&#46; La multiparidad y la cirug&#237;a p&#233;lvica previa se identificaron como factores predisponentes para el fracaso del tratamiento&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Las participantes en nuestro estudio fueron 51 mujeres con una edad media de 62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 a&#241;os&#44; un IMC medio de 28&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;84<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y una media de 2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 partos vaginales cada una&#46; Estas caracter&#237;sticas son similares a las descritas por Ko&#322;ody&#324;ska et al&#46; para su poblaci&#243;n de estudio<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La multiparidad y la cirug&#237;a ginecol&#243;gica previa se identificaron como factores independientes de fracaso del tratamiento&#44; que se produjo en el 12&#37; de nuestra cohorte&#46; Estos resultados est&#225;n en consonancia con la mayor&#237;a de los resultados comunicados&#44; como en el caso del metaan&#225;lisis reciente de Falah-Hassani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a>&#44; en el que se observ&#243; que el riesgo de IUE en general aumentaba con la multiparidad&#44; la obesidad y el tabaquismo&#46; En la revisi&#243;n realizada por Capobianco et al&#46;&#44; los factores de riesgo que mostraron asociaci&#243;n con la recurrencia o persistencia de la IUE tras la cirug&#237;a fueron la edad&#44; la obesidad&#44; las comorbilidades &#40;por ejemplo&#44; diabetes mellitus&#41;&#44; los antecedentes de IUE previa&#44; la IU mixta y el fracaso de una cirug&#237;a previa para la incontinencia<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En nuestra cohorte&#44; la obesidad se mostr&#243; como un factor asociado a un peor pron&#243;stico en t&#233;rminos de calidad de vida tras el tratamiento quir&#250;rgico&#46; Estos resultados son similares a los de algunos estudios que han realizado un seguimiento de pacientes sometidas a este tratamiento&#46; As&#237;&#44; Hagan et al&#46; detectaron una fuerte relaci&#243;n entre un IMC m&#225;s elevado y la progresi&#243;n de la severidad de la IU&#44; independientemente de la edad<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a>&#46; Resultados similares fueron comunicados por Lamerton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a>&#44; quienes mencionaron que la relaci&#243;n entre obesidad e IU era un problema de salud p&#250;blica&#44; ya que se espera un aumento continuo de las tasas de obesidad y&#44; por tanto&#44; de las tasas de IU&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Como se ha se&#241;alado anteriormente&#44; la IU tiene repercusiones psicol&#243;gicas y afecta significativamente a la calidad de vida&#44; y esto debe tenerse en cuenta a la hora de evaluar la eficacia del tratamiento<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;12</span></a>&#46; La International Continence Society recomienda la inclusi&#243;n de la calidad de vida como variable de resultado en los ensayos cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a>&#46; Adem&#225;s&#44; seg&#250;n el National Institute for Health and Clinical Excellence del Reino Unido&#44; se necesitan cuestionarios validados sobre calidad de vida para elegir el mejor tratamiento para cada individuo&#46; Sin embargo&#44; los diferentes cuestionarios var&#237;an y no hay consenso sobre cu&#225;l ofrece los mejores resultados&#46; Uno de los cuestionarios utilizados en nuestro estudio fue el ICIQ-UI-SF&#46; En una revisi&#243;n sistem&#225;tica reciente realizada por Wuytack et al&#46; se observ&#243; que este instrumento indicaba un resultado satisfactorio con una especificidad del 85&#37; y una sensibilidad del 90&#37; cuando la puntuaci&#243;n era superior a 6<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a>&#46; La versi&#243;n espa&#241;ola del ICIQ-UI-SF ha demostrado fiabilidad&#44; consistencia interna y validez para describir el impacto de la IU en la calidad de vida&#44; as&#237; como para diagnosticar el tipo de IU en la pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a>&#46; En el postratamiento a largo plazo &#40;5 a&#241;os&#41;&#44; observamos una reducci&#243;n media significativa de 8&#44;78 puntos en la puntuaci&#243;n obtenida en el ICIQ-UI-SF&#46; Esta cifra es ligeramente superior a la obtenida en el estudio de Croghan et al&#46;&#44; en el que detectaron una reducci&#243;n media en la puntuaci&#243;n del ICIQ-UI-SF de 6&#44;32&#44; aunque con 9&#44;4 a&#241;os de seguimiento<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Seg&#250;n las recomendaciones de la European Association of Urology&#44; el primer tratamiento de la IU debe ser de tipo conservador<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a>&#46; En la revisi&#243;n sistem&#225;tica publicada por Radzimi&#324;ska et al&#46; se concluy&#243; que la rehabilitaci&#243;n del suelo p&#233;lvico mediante al menos 6 meses de fisioterapia era la opci&#243;n m&#225;s efectiva para la IUE<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Ante el fracaso del tratamiento conservador o en casos de IU grave&#44; est&#225; indicado el tratamiento quir&#250;rgico<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;16</span></a>&#46; El objetivo del tratamiento quir&#250;rgico es restaurar la anatom&#237;a y las funciones del sistema urinario&#46; La elevada tasa de complicaciones asociadas al abordaje retrop&#250;bico &#40;TVT&#41; condujo al desarrollo de los cabestrillos suburetrales insertados a trav&#233;s del agujero obturador&#44; que incluyen los procedimientos fuera-dentro &#40;TOT&#41; o dentro-fuera &#40;TVT-O&#41;&#46; Como se concluye en el metaan&#225;lisis de Huang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a>&#44; el abordaje transobturador muestra una eficacia similar y una tasa menor de complicaciones&#44; adem&#225;s de reducir los tiempos quir&#250;rgicos y la estancia hospitalaria&#46; En nuestro estudio no se encontraron diferencias entre las t&#233;cnicas TOT y TVT-O&#44; como confirman los metaan&#225;lisis de Oliveira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> y Fusco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La tasa de complicaciones registrada en nuestras pacientes fue inferior a la comunicada en series similares&#46; Frohme et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> obtuvieron una tasa de complicaciones intraoperatorias del 23&#44;2&#37; &#40;27&#47;116 mujeres&#41;&#44; y la mayor&#237;a fueron menores &#40;tenesmo <span class="elsevierStyleItalic">de novo</span>&#44; dispareunia&#44; retenci&#243;n urinaria y perforaci&#243;n vaginal&#41;&#46; En una cohorte de edad e IMC similares a las del presente estudio&#44; Natale et al&#46; observaron una tasa de urgencia miccional <span class="elsevierStyleItalic">de novo</span> del 6&#44;4&#37; en la revisi&#243;n a 5 a&#241;os&#44; frente a nuestra tasa del 4&#37;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En nuestra cohorte se obtuvo una tasa de extrusi&#243;n de la malla del 4&#37;&#44; similar a las cifras comunicadas del 4&#44;5&#37; &#40;14&#47;314 mujeres&#41; por Karmakar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> y del 4&#44;2&#37; &#40;61&#47;1&#46;439 mujeres&#41; por Kokanali et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a>&#44; y evidencia el antecedente de cirug&#237;a p&#233;lvica previa como factor pron&#243;stico para la extrusi&#243;n de la malla&#46; Sin embargo&#44; en una revisi&#243;n de Linder y Elliott se describi&#243; una tasa menor de extrusi&#243;n de la malla &#40;1&#44;5-2&#37; de los casos&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a>&#46; No obstante&#44; estos autores detectaron la aparici&#243;n de lesiones vasculares &#40;hematoma p&#233;lvico&#41; hasta en un 2&#37; de las pacientes tras la inserci&#243;n de la cinta transobturadora&#44; frente a nuestra tasa del 0&#37;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Las cifras de fracaso del tratamiento quir&#250;rgico para la IU son muy heterog&#233;neas&#46; As&#237;&#44; para la colocaci&#243;n del cabestrillo mediouretral con t&#233;cnica de incisi&#243;n &#250;nica&#44; Henry de Villeneuve et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> registraron una tasa de fracaso del 14&#44;2&#37; a los 12 meses&#44; mientras que Pardo Schanz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> obtuvieron una tasa de fracaso del 5&#37;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Debido al debilitamiento de las estructuras p&#233;lvicas&#44; el prolapso de &#243;rganos p&#233;lvicos y la IU son enfermedades con frecuencia concomitantes&#46; En estas pacientes&#44; la cirug&#237;a simult&#225;nea para la incontinencia y la reparaci&#243;n del prolapso de &#243;rganos p&#233;lvicos ha demostrado reducir el riesgo de IUE postoperatoria<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a>&#46; Esto se reflej&#243; en nuestra cohorte&#44; en la que el 43&#44;2&#37; de las mujeres se sometieron a cirug&#237;a simult&#225;nea&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Entre las limitaciones de nuestro estudio se encuentra el dise&#241;o retrospectivo unic&#233;ntrico en el que se incluyeron pacientes con un perfil epidemiol&#243;gico caracter&#237;stico &#40;mujeres de edad avanzada con altos &#237;ndices de obesidad&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La IU es una enfermedad cr&#243;nica infradiagnosticada que&#44; adem&#225;s de tener repercusiones f&#237;sicas&#44; tiene un considerable impacto social y psicol&#243;gico&#46; Dado que la consecuencia de esta enfermedad es el empeoramiento significativo de la calidad de vida&#44; su diagn&#243;stico y tratamiento deben ser prioritarios&#44; ya que como respuesta&#44; la calidad de vida mejora significativamente&#46; A la hora de considerar el tratamiento quir&#250;rgico&#44; se deben valorar diversos factores como la multiparidad&#44; la obesidad y la cirug&#237;a p&#233;lvica previa&#44; ya que pueden asociarse a resultados deficientes a largo plazo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0175" class="elsevierStylePara elsevierViewall">Nuestros resultados indican una mejora de la calidad de vida en las mujeres con IUE a los 5 a&#241;os del tratamiento quir&#250;rgico&#44; la cual se manifiesta en una reducci&#243;n significativa de las puntuaciones en los cuestionarios para evaluar la calidad de vida&#46; En esta cohorte&#44; la multiparidad y la cirug&#237;a p&#233;lvica previa surgieron como factores predisponentes para el fracaso del tratamiento&#44; y la obesidad se asoci&#243; a una calidad de vida menor&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0180" class="elsevierStylePara elsevierViewall">No se ha recibido financiaci&#243;n&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflictos de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Este estudio descriptivo examina la calidad de vida de mujeres sometidas a colocaci&#243;n de cabestrillo mediouretral para el tratamiento de la incontinencia urinaria de esfuerzo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio retrospectivo de cohortes basado en datos de 51 pacientes sometidas consecutivamente a este procedimiento en un hospital terciario&#160;en los a&#241;os 2014 y 2015&#46; La principal variable de resultado fue la calidad de vida evaluada mediante el cuestionario de severidad de Sandvick y el cuestionario breve de calidad de vida de la International Consultation on Incontinence &#40;ICIQ-UI-SF&#41; en el preoperatorio&#44; y en revisiones a los 6 meses y a los 5 a&#241;os de la cirug&#237;a&#46; Los factores asociados con el fracaso del tratamiento se evaluaron mediante regresi&#243;n log&#237;stica binaria&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#160;los 5 a&#241;os de la cirug&#237;a se obtuvo una reducci&#243;n absoluta de 8&#44;78 puntos &#40;IC 95&#37; 6&#44;43-11&#44;14&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en el cuestionario ICIQ-UI-SF y de 4&#44;54 &#40;IC 95&#37; 3&#44;25-5&#44;83&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;00&#41; en el test de severidad de Sandvick con respecto a la puntuaci&#243;n basal&#44; en las 35 pacientes que completaron el seguimiento&#46; En las 51 pacientes intervenidas la tasa de &#233;xito en cuanto a la correcci&#243;n de la incontinencia fue del 86&#44;3&#37; &#40;44&#47;50&#41;&#44; con una tasa de fracaso del 12&#37; &#40;6&#47;50&#41;&#46;&#160;La multiparidad y la cirug&#237;a ginecol&#243;gica previa se identificaron como factores predisponentes para el fracaso de la t&#233;cnica&#46; La obesidad se asoci&#243; con un peor resultado del tratamiento&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con cabestrillo para la incontinencia fue exitoso en el 86&#44;3&#37; &#40;44&#47;50&#41; de las participantes y sigui&#243; siendo eficaz 5 a&#241;os despu&#233;s de la cirug&#237;a en t&#233;rminos de calidad de vida&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015&#46; The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Form quality of life questionnaire &#40;ICIQ-UI-SF&#41; at the time points baseline or presurgery&#44; and 6 months and 5 years postsurgery&#46; Factors associated with treatment failure were determined through binary logistic regression&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">At 5-year follow-up we obtained an absolute reduction of 8&#46;78 points &#40;95&#37; CI 6&#46;43-11&#46;14&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the ICIQ-UI-SF and 4&#46;54 &#40;95&#37; CI 3&#46;25-5&#46;83&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the Sandvick severity test score&#44; compared to baseline&#44; in the 35 patients that completed follow-up&#46; Out of the 51 patients that were followed&#44; the rate of success in incontinence correction was 86&#46;3&#37; &#40;44&#47;50&#41; with a failure rate of 12&#37; &#40;6&#47;50&#41;&#46; Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure&#46; Obesity was associated with a worse treatment outcome&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sling treatment for incontinence was successful in 86&#46;3&#37; &#40;44&#47;50&#41; of participants and remained effective 5 years after surgery in terms of quality of life&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Puntuaciones obtenidas en el cuestionario de calidad de vida International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form &#40;ICIQ-UI-SF&#41; a lo largo del tiempo &#40;basal&#44; 6 meses y 5 a&#241;os postoperatorio&#41; seg&#250;n el &#237;ndice de masa corporal &#40;IMC&#41;&#46;</p>"
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                  \t\t\t\t">74&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">H&#225;bito tab&#225;quico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumadora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exfumadora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Carga laboral&#47;ejercicio f&#237;sico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes mellitus</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad neurol&#243;gica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cirug&#237;as previas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HT abdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HT vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>POP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IUE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Otras cirug&#237;as previas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>POP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Menopausia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grado cistocele</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IUE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IUM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cirug&#237;a</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TOT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TOT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>POP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TOT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cirug&#237;a abdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Abordaje quir&#250;rgico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TOT &#40;fuera-dentro&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TVT-O &#40;dentro-fuera&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones intraoperatorias</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Perforaci&#243;n vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones postoperatorias</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retenci&#243;n urinaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Extrusi&#243;n de la malla</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Urgencia de novo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fracaso de la t&#233;cnica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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Información del artículo
ISSN: 02104806
Idioma original: Español
DOI:10.1016/j.acuro.2024.05.003
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Junio 5 8 13

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