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Beilecke K, Soeder S, Hufenbach E, Tunn R. Impact of Retropubic vs. Transobturator Slings for Urinary Incontinence on Myofascial Structures of the Pelvic Floor, Adductor and Abdominal Muscles. Geburtshilfe Frauenheilkd 2014; 74:69-74. [PMID: 24741121 PMCID: PMC3964350 DOI: 10.1055/s-0033-1360222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 10/16/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022] Open
Abstract
Suburethral tension-free slings (tapes or bands) are an essential component in the operative treatment of urinary incontinence. In the present contribution the influence of the type of suburethral sling (retropubic vs. transobturator) on the myofascial structures of the abdominal, adductor and pelvic floor muscles is examined. For this purpose, 70 patients were prospectively observed clinically and physiotherapeutically. Significant differences were seen in the improvement of the pelvic floor musculature (strength, endurance, speed) after placement of a suburethral sling, irrespective of whether it was of the retropubic or the transobturator type. Thus, after surgical treatment patients should be encouraged to undertake further pelvic floor exercising or this should be prescribed for them. There were no significant changes in the abdominal and adductor muscles but there were slight increases with regard to pain level, pain on palpation, and trigger points after placement of both types of sling; thus this is not a criterion in the decision as to which type of sling to use.
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Affiliation(s)
- K. Beilecke
- DBBZ, Klinik für Urogynäkologie, St. Hedwig Krankenhaus,
Berlin
| | - S. Soeder
- Praxis für Physiotherapie, DBBZ, Berlin
| | - E. Hufenbach
- Frauenklinik, Vivantes-Klinikum Hellersdorf, Berlin
| | - R. Tunn
- DBBZ, Klinik für Urogynäkologie, St. Hedwig Krankenhaus,
Berlin
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152
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Sergent F, Gay-Crosier G, Resch B, Pons JC, Marpeau L. [A comparative study between two procedures of TVT retropubic mid-urethral sling placement for treatment of female stress urinary incontinence]. ACTA ACUST UNITED AC 2013; 43:235-43. [PMID: 24332758 DOI: 10.1016/j.jgyn.2013.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/24/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. PATIENTS AND METHODS Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. RESULTS One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (P<0.05), those of reoperations for pulling the sling downward 11.1% and 1.5% (P<0.05). A 1 year and more, healing and satisfaction rates were respectively 83.3% and 79.2% for the standard TVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (P<0.05). CONCLUSION By modifying the placement of the classic TVT, it is possible to reduce its complications while maintaining its efficacy.
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Affiliation(s)
- F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France.
| | - G Gay-Crosier
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Resch
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - J-C Pons
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France
| | - L Marpeau
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Faculté mixte de médecine et de pharmacie de Rouen, 22, boulevard Gambetta, CS 76183, 76183 Rouen cedex 01, France
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153
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Affiliation(s)
- R Kavia
- Northwick Park Hospital, Harrow, UK
| | - Tg Rashid
- University College Hospital, London, UK
| | - Jl Ockrim
- University College Hospital, London, UK
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154
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O'Sullivan OE, Martyn F, O'Connor R, Jaffery S. Novel endoscopic management of a late complication following TVT insertion for stress urinary incontinence. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:459-61. [PMID: 24222816 PMCID: PMC3821708 DOI: 10.12659/ajcr.889571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/12/2013] [Indexed: 11/09/2022]
Abstract
Patient: Female, 57 Final Diagnosis: Bladder erosion Symptoms: Haematuria • irritative bladder symptoms • recurrent UTI Medication: — Clinical Procedure: Endoscopic tape resection Specialty: Urology
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Abstract
OBJECTIVE To assess the effectiveness of mesh compared with nonmesh slings placed in different surgical settings as measured by the frequency of complications within 1 year. METHODS We performed a retrospective cohort study of Medicare beneficiaries undergoing sling surgery from 2006 to 2008 in hospital outpatient departments and hospital-based ambulatory surgery centers. Slings were identified and categorized according to the use of mesh by Healthcare Common Procedure Coding System codes and temporary "C" Healthcare Common Procedure Coding System codes. Patients were followed for 1 year after each procedure to identify complications. Logistic models were fit to assess relationships among sling type, surgical setting, and various complications. RESULTS We identified 6,698 Medicare beneficiaries who underwent mesh sling procedures and 445 Medicare beneficiaries who underwent nonmesh sling procedures. The overall frequency of complications was similar between the two groups at 69.8% and 72.6% in the mesh and nonmesh groups, respectively (P=.22). Infectious complications were the most common complication at 45.4% and 50.1% of the mesh and nonmesh groups, respectively (P=.06). Patients undergoing mesh procedures were less likely than patients undergoing nonmesh procedures to require management for bladder outlet obstruction (13.9% compared with 19.3%, adjusted odds ratio [OR] 0.66, 95% confidence interval [CI] 0.52-0.85) and were less likely to have a subsequent sling removal and revision or urethrolysis (2.7% compared with 4.7%, adjusted OR 0.56, 95% CI 0.35-0.89). CONCLUSION Frequencies of most complications were similar regardless of the use of mesh except for the management of bladder outlet obstruction. These results did not differ based on the surgical setting where the sling procedure was performed. LEVEL OF EVIDENCE II.
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156
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Words of wisdom. Re: Multicenter prospective randomized study of single-incision mini-sling vs tension-free vaginal tape-obturator in management of female stress urinary incontinence: a minimum of 1-year follow-up. Eur Urol 2013; 64:1017. [PMID: 24209452 DOI: 10.1016/j.eururo.2013.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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157
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Hajiabbas M, Mashayekhan S, Nazaripouya A, Naji M, Hunkeler D, Rajabi Zeleti S, Sharifiaghdas F. Chitosan-gelatin sheets as scaffolds for muscle tissue engineering. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2013; 43:124-32. [DOI: 10.3109/21691401.2013.852101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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158
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Athanasopoulos A. Editorial Comment. Urology 2013; 82:1042-3. [DOI: 10.1016/j.urology.2013.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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159
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Palomba S, Oppedisano R, Falbo A, Torella M, Maiorana A, Materazzo C, Tolino A, Mastrantonio P, La Sala GB, Alio L, Colacurci N, Zullo F. Single-incision mini-slings versus retropubic tension-free vaginal tapes: a multicenter clinical trial. J Minim Invasive Gynecol 2013; 21:303-10. [PMID: 24148568 DOI: 10.1016/j.jmig.2013.08.714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/14/2013] [Accepted: 08/25/2013] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To compare single-incision mini-slings (SIMSs) and retropubic tension-free vaginal tape (r-TVT) in terms of the long-term efficacy and safety for the treatment of female stress (SUI) or mixed urinary incontinence (MUI). DESIGN Prospective multicenter cohort trial (registration number NCT00751088) (Canadian Task Force II). SETTINGS Department of Obstetrics and Gynecology, Italy. PATIENTS Two hundred-forty women with SUI/MUI. INTERVENTIONS SIMS or r-TVT. MEASUREMENTS AND MAIN RESULTS The operative time and the use of analgesic tablets were significantly (p < .001) higher and lower, respectively, in the r-TVT group versus the SIMS group. After 24 months of follow-up, no difference between the study arms was observed in terms of the complication rate (30/120 [25%] vs 19/120 [15.8%] for the r-TVT and SIMS arms, respectively; relative risk = 1.58; 95% confidence interval, 0.94-2.65; p = .083), whereas the subjective cure rate was significantly lower in the SIMS arm than in the r-TVT arm (57/103 [55.3%] vs 89/106 [84.0%] for the r-TVT and SIMS arms, respectively; relative risk = 0.66; 95% confidence interval, 0.54-0.80]; p < .001). The proportion of retreated patients for SUI/MUI was significantly higher in the SIMS arm than in the r-TVT arm (37/103 [34.9%] vs 12/106 [11.3%] for SIMS and r-TVT arm, respectively; p < .001). CONCLUSION SIMS has no advantage in terms of safety over r-TVT and was found to be less effective than r-TVT. Thus, its use in the clinical practice should be questioned.
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Affiliation(s)
- Stefano Palomba
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliera "Santa Maria Nuova," Istituto di Ricovero e Cura a Carattere Scientifico, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
| | - Rosamaria Oppedisano
- Departments of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Angela Falbo
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliera "Santa Maria Nuova," Istituto di Ricovero e Cura a Carattere Scientifico, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Marco Torella
- Departments of Obstetrics and Gynecology, Second University of Naples, Naples, Italy
| | - Antonio Maiorana
- Unit of Obstetrics and Gynecology, Hospital "Civico" of Palermo, Palermo, Italy
| | - Caterina Materazzo
- Departments of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Achille Tolino
- Department of Obstetrics and Gynecology, University "Federico II" of Naples, Naples, Italy
| | | | - Giovanni B La Sala
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliera "Santa Maria Nuova," Istituto di Ricovero e Cura a Carattere Scientifico, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Alio
- Unit of Obstetrics and Gynecology, Hospital "Civico" of Palermo, Palermo, Italy
| | - Nicola Colacurci
- Departments of Obstetrics and Gynecology, Second University of Naples, Naples, Italy
| | - Fulvio Zullo
- Departments of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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160
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Lee D, Murray S, Bacsu CD, Zimmern PE. Long-term outcomes of autologous pubovaginal fascia slings: is there a difference between primary and secondary slings? Neurourol Urodyn 2013; 34:18-23. [PMID: 24132988 DOI: 10.1002/nau.22502] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/17/2013] [Indexed: 11/07/2022]
Abstract
INTRODUCTION To report our long-term pubovaginal slings (PVS) outcomes between primary (PVS1) and secondary (PVS2) autologous fascia PVS, with the hypothesis that outcomes in PVS1 will be better than in PVS2. MATERIALS AND METHODS IRB approved retrospective study of women undergoing PVS between 1996 and 2011 with minimum 6 months follow-up. Data reviewed included demographics, questionnaires that is, UDI-6, IIQ-7, QOL, prior anti-incontinence procedure, associated repairs, urodynamic findings and repeat procedures. Primary outcome and surgical success defined by: (1) QOL ≤ 3, (2) UDI question 3 on SUI ≤ 1, and (3) no SUI re-treatment/operation. Secondary outcomes included all other patient reported outcome measures (PROM). RESULTS Of 110 patients, 84 had follow-up. Mean age was 61 years (38-88) and median follow-up was 89 months (7-189). Demographic findings and type of fascia used were similar between the two groups. Mean postoperative scores were not statistically significant for total UDI-6 score (P = 0.62), IIQ-7 (P = 0.30) and QOL (P = 0.35) between groups, but was statistically significant compared to baseline (P = 0.001) as expected. Twelve patients, 3 in PVS1 and 9 in PVS2 underwent subsequent procedures. Surgical success rate was 76% in PVS1 and 52% in PVS2 for those with completed questionnaires. Overall, 78% (28) in PVS1 and 69% (33) in PVS 2 required no further surgical intervention at last follow-up. CONCLUSION At long-term follow-up of average 7.4 years, primary and secondary PVS patients had comparable favourable functional outcomes with low morbidity. However, secondary PVS patients had lower success rates as per our definition with higher rate of additional procedures.
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Affiliation(s)
- Dominic Lee
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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161
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Schätz T, Hruby S, Colleselli D, Janetschek G, Lusuardi L. A severe complication of mid-urethral tapes solved by laparoscopic tape removal and ureterocutaneostomy. Can Urol Assoc J 2013; 7:E598-600. [PMID: 24069104 DOI: 10.5489/cuaj.393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mid-urethral tapes are largely used to manage stress urinary incontinence (SUI). In certain cases, however, this procedure results in bothersome complications that lead to complete resection. We present the case of an 85-year-old woman who presented with ongoing suprapubic pain, hematuria, vaginal bleeding and recurrent urinary tract infections. The patient had undergone a tension-free vaginal tape (TVT) procedure in 1999 and a transobturator tape (TOT) placement in 2003 for SUI. Investigations revealed a urethral stone, erosion of both TOT and TVT and an urethra-vaginal fistula. Under local anesthesia the urethral stone was removed endoscopically and the TOT removed via a vaginal approach. Due to her comorbidity, she underwent a laparoscopic intraperitoneal removal of the TVT and a definitive ureterocutaneostomy to relieve her pain, inflammation and incontinence. This is the first ever presented case of erosion of mid-urethral tapes and incontinence treated with a laparoscopic resection of the tape and ureterocutaneostomy as definitive urinary diversion.
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Affiliation(s)
- Tobias Schätz
- Paracelsus Medical University Salzburg, Department of Urology and Andrology, Salzburg, Austria
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162
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Tantanasis T, Daniilidis A, Pantelis A, Chatzis P, Vrachnis N. Minimally invasive techniques for female stress urinary incontinence, how, why, when. Arch Gynecol Obstet 2013; 288:995-1001. [PMID: 24052223 DOI: 10.1007/s00404-013-3024-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
AIM The main purpose of this paper is to summarize the recent experience that has been obtained till now in the surgical treatment of urinary stress incontinence with less invasive techniques. MATERIALS AND METHODS We used current literature and papers published in MEDLINE and Cochrane library. The keywords used for this review were Stress urinary incontinence, Tension-free vaginal tape (TVT), Transobturator tape (TOT, TVT-O), and Single-incision mini-slings (SIMS). RESULTS Tension-free vaginal tape and the transobturator urethral suspension are the most commonly used surgical approach for women who suffer from stress urinary incontinence, with long-term success rates ranging from 84 to 95 %. TVT is shown to be as effective as the older colposuspension, associated with less post-operative complications, shorter hospital stay and shorter recovery period. Bladder perforations that have been mentioned with the TVT inserter apparently do not result in any clinically significant morbidity. Major vascular and bowel injuries have been reported at rates of 0.07 and 0.04 %, respectively. Studies between TVT-O and TOT show equal effectiveness with slightly lower cure rates than TVT group, but TOT had a significant lower risk of bladder and vaginal perforations. There were no significant differences in objective cure rates between 'inside-out' and 'outside-in' transobturator tapes. Very recently a meta-analysis does not support routine use of SIMS in clinical practice, moreover suggested the retropubic TVT as the preferred choice for the management of stress urinary incontinence due to familiarity, its effectiveness, minimal invasiveness and low complication and morbidity rates as a primary procedure. Similar results have been announced in a randomized control trial in USA. CONCLUSIONS Certainly, larger randomized clinical trials with longer follow-up about the mentioned techniques are needed to accurately determine the efficacy and safety of the mentioned minimally invasive techniques.
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Affiliation(s)
- Theocharis Tantanasis
- 2nd University Department of Obstetrics of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
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Labrie J, Berghmans BLCM, Fischer K, Milani AL, van der Wijk I, Smalbraak DJC, Vollebregt A, Schellart RP, Graziosi GCM, van der Ploeg JM, Brouns JFGM, Tiersma ESM, Groenendijk AG, Scholten P, Mol BW, Blokhuis EE, Adriaanse AH, Schram A, Roovers JPWR, Lagro-Janssen ALM, van der Vaart CH. Surgery versus physiotherapy for stress urinary incontinence. N Engl J Med 2013; 369:1124-33. [PMID: 24047061 DOI: 10.1056/nejmoa1210627] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial therapy. METHODS We performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence. Crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months. RESULTS We randomly assigned 230 women to the surgery group and 230 women to the physiotherapy group. A total of 49.0% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. In an intention-to-treat analysis, subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference, 26.4 percentage points; 95% confidence interval [CI], 18.1 to 34.5). The rates of subjective cure were 85.2% in the surgery group and 53.4% in the physiotherapy group (absolute difference, 31.8 percentage points; 95% CI, 22.6 to 40.3); rates of objective cure were 76.5% and 58.8%, respectively (absolute difference, 17.8 percentage points; 95% CI, 7.9 to 27.3). A post hoc per-protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery. CONCLUSIONS For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).
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Affiliation(s)
- Julien Labrie
- University Medical Center Utrecht, Utrecht, The Netherlands.
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Serati M. Mini-slings for female urinary stress incontinence: a promising option, but what comes later is not always progress. Eur Urol 2013; 65:428-9. [PMID: 24035681 DOI: 10.1016/j.eururo.2013.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/19/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy.
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165
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Verghese T, Latthe P. Recent status of the treatment of stress urinary incontinence. Int J Urol 2013; 21:25-31. [PMID: 23944714 DOI: 10.1111/iju.12238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/28/2013] [Indexed: 12/15/2022]
Abstract
The therapeutic options for management of stress urinary incontinence can be conservative, pharmacological or surgical. The treatment of patients with stress urinary incontinence should be tailored to the individual to optimize care. A multitude of surgical techniques have emerged to treat this condition in recent years. The objective of the present review was to present an overview of current practice in the management of stress urinary incontinence while considering the evidence supporting the clinical effectiveness of these procedures.
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Affiliation(s)
- Tina Verghese
- Department of Obstetrics and Gynecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
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van Leijsen SAL, Kluivers KB, Mol BWJ, Vierhout ME, Heesakkers JPFA. Authors' response re: Do preoperative urodynamics still have a role in female stress urinary incontinence? Neurourol Urodyn 2013;32:1144-5. Neurourol Urodyn 2013; 32:1146-7. [PMID: 23925729 DOI: 10.1002/nau.22339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Chapple CR, Raz S, Brubaker L, Zimmern PE. Mesh sling in an era of uncertainty: lessons learned and the way forward. Eur Urol 2013; 64:525-9. [PMID: 23856039 DOI: 10.1016/j.eururo.2013.06.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/24/2013] [Indexed: 01/27/2023]
Abstract
Following transvaginal mesh, synthetic slings to correct stress urinary incontinence have been put under further scrutiny. Since the recent FDA website update, we reviewed the latest developments and then reflected on the lessons learned by applying this process and the way forward.
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A systematic review of the treatment for female stress urinary incontinence by ACT® balloon placement (Uromedica, Irvine, CA, USA). World J Urol 2013; 32:495-505. [DOI: 10.1007/s00345-013-1117-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022] Open
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169
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Barboglio PG, Gormley EA. Retropubic Versus Transobturator Slings—Are the Outcomes Changing with Time? Curr Urol Rep 2013; 14:386-94. [DOI: 10.1007/s11934-013-0337-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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170
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Urogenital consequences in ageing women. Best Pract Res Clin Obstet Gynaecol 2013; 27:699-714. [PMID: 23764480 DOI: 10.1016/j.bpobgyn.2013.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 02/20/2013] [Accepted: 03/22/2013] [Indexed: 12/18/2022]
Abstract
Various anatomical, physiological, genetic, lifestyle and reproductive factors interact throughout a woman's life span and contribute to pelvic floor disorders. Ageing affects pelvic floor anatomy and function, which can result in a variety of disorders, such as pelvic organ prolapse, lower urinary tract symptoms, dysfunctional bowel and bladder evacuation, and sexual dysfunction. The exact mechanisms and pathophysiological processes by which ageing affects pelvic floor and lower urinary and gastrointestinal tract anatomy and function are not always clear. In most cases, it is difficult to ascertain the exact role of ageing per se as an aetiological, predisposing or contributing factor. Other conditions associated with ageing that may co-exist, such as changes in mental status, can result in different types of pelvic floor dysfunction (e.g. functional incontinence). Pelvic organ dysfunction may be associated with significant morbidity and affect quality of life. These groups of patients often pose difficult diagnostic and therapeutic dilemmas owing to complex medical conditions and concurrent morbidities. In this chapter, we summarise the current evidence on the management of pelvic floor disorders, with emphasis on elderly women and the associations between the ageing process and these disorders. Clinicians with an understanding of the affect of ageing on the pelvic floor and lower urinary and gastrointestinal tract anatomy and function, and the complex interplay of other comorbidities, will be able to investigate, diagnose and treat appropriately there women. A holistic approach may result in substantial improvements in their quality of life.
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Barboglio PG, Ann Gormley E. The fate of synthetic mid-urethral slings in 2013: A turning point. Arab J Urol 2013; 11:117-26. [PMID: 26558068 PMCID: PMC4442984 DOI: 10.1016/j.aju.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. METHODS For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both 'index patients' (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. RESULTS Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. CONCLUSION MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and are dependent on technique.
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Key Words
- DUPS, distal urethral polypropylene sling
- FDA, United States food and drug administration
- ISD, intrinsic sphincteric deficiency
- MUS, Mid-urethral sling
- Mid-urethral
- OR, odds ratio
- POP, pelvic organ prolapse
- PVS, pubovaginal sling
- RCT, randomised controlled trial
- RMUS, retropubic mid-urethral sling
- RR, relative risk
- Retropubic
- SIS, single-incision sling
- SUI, stress urinary incontinence
- Sling
- Stress urinary incontinence
- Synthetic
- TFS, tissue-fixation mini-sling
- TMUS, transobturator mid-urethral sling
- TOT, transobturator tape
- TVT, tension-free vaginal tape
- TVT-O, TVT-obturator
- TVT-S, TVT-Secur
- Transobturator tape
- UITN, urinary incontinence treatment network
- VLPP, Valsalva leak-point pressure
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Affiliation(s)
| | - E Ann Gormley
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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173
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Ahn KH, Alvarez J, Dwyer PL. Recent Developments in the Surgical Management of Urinary Stress Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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174
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Indications, Contraindications, and Complications of Mesh in the Surgical Treatment of Urinary Incontinence. Clin Obstet Gynecol 2013; 56:257-75. [DOI: 10.1097/grf.0b013e31828563d2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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175
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Waltregny D. TVT-O: A New Gold Standard Surgical Treatment of Female Stress Urinary Incontinence? Eur Urol 2013; 63:879-80. [DOI: 10.1016/j.eururo.2013.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
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176
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Agur W, Riad M, Secco S, Litman H, Madhuvrata P, Novara G, Abdel-Fattah M. Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. Eur Urol 2013; 64:323-36. [PMID: 23680414 DOI: 10.1016/j.eururo.2013.04.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/16/2013] [Indexed: 12/12/2022]
Abstract
CONTEXT Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment. OBJECTIVE To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI. EVIDENCE ACQUISITION A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5. EVIDENCE SYNTHESIS We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41-1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86-3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85-10.57, and OR: 3.32; 95% CI, 0.96-11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01-8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13-2.05). CONCLUSIONS This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma.
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Affiliation(s)
- Wael Agur
- NHS Ayrshire & Arran, NHS Research Scotland, Kilmarnock, UK.
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177
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Desseauve D, Pierre F, Fritel X. Urinary incontinence in women: Study of surgical practice in France. Prog Urol 2013; 23:249-55. [DOI: 10.1016/j.purol.2012.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/09/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
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178
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Réintervention par bandelette sous-urétrale pour récidive d’incontinence urinaire d’effort féminine après une première bandelette sous-urétrale. Prog Urol 2013; 23:262-9. [DOI: 10.1016/j.purol.2013.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 11/19/2022]
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179
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Tommaselli GA, D’Afiero A, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Tension-Free Vaginal Tape-O and -Secur for the Treatment of Stress Urinary Incontinence: A Thirty-Six–Month Follow-Up Single-Blind, Double-Arm, Randomized Study. J Minim Invasive Gynecol 2013; 20:198-204. [DOI: 10.1016/j.jmig.2012.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
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180
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Lutz AT, Winters JC. Guidelines and Practice Standardization for Female Stress Urinary Incontinence (SUI). CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-012-0169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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181
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Bakali E, Buckley BS, Hilton P, Tincello DG. Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women. Cochrane Database Syst Rev 2013:CD009407. [PMID: 23450602 DOI: 10.1002/14651858.cd009407.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Surgery is a common treatment modality for stress urinary incontinence (SUI), usually offered for women who fail conservative treatments. Suburethral tapes have superseded colposuspension because cure rates are comparable and recovery time reduced. However, some women will not be cured after suburethral tape surgery, and currently there is no consensus on how to manage these women. OBJECTIVES To obtain and examine evidence supporting different management strategies for recurrent/persistent stress urinary incontinence (SUI) in women after failed suburethral tape surgery. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register of controlled trials (searched 18 December 2012), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and PreMEDLINE; and handsearched journals and conference proceedings, and the reference lists of included studies and previous Cochrane reviews for randomised or quasi-randomised studies treating patients with recurrent incontinence, either as the sole population or a subset. Conservative, medical and surgical treatments were included. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials in women who had recurrent urinary incontinence after previous minimally invasive suburethral tape surgery. DATA COLLECTION AND ANALYSIS Abstracts of identified studies were checked by two authors to confirm eligibility. Full text reports of relevant studies were obtained, and authors were contacted directly where necessary. Outcome data were extracted onto a standard proforma and processed according to the methods in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Twelve studies were identified, but all were excluded because they did not meet the eligibility criteria. Six were randomised controlled trials (RCTs) but were not eligible because the previous incontinence surgery was not a suburethral tape. A subset of one RCT may have been eligible for inclusion because some of the women were having repeat surgery, but we were unable to obtain from the authors the data according to primary surgery for this cohort. AUTHORS' CONCLUSIONS There were no data to recommend or refute any of the different management strategies for recurrent or persistent stress incontinence after failed suburethral tape surgery. Evidence is urgently required to address this deficiency, ideally from RCTs.
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Affiliation(s)
- Evangelia Bakali
- Obstetrics and Gynaecology, Leicester General Hospital, Leicester, UK
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182
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Serati M, Cattoni E, Siesto G, Braga A, Sorice P, Cantaluppi S, Cromi A, Ghezzi F, Vitobello D, Bolis P, Salvatore S. Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence? BJU Int 2013; 112:E344-50. [PMID: 23421421 DOI: 10.1111/bju.12007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To identify how many patients with symptoms of pure stress urinary incontinence (SUI) do not require any surgical treatment on the basis of urodynamics (UDS) and how many patients still do not require surgery 1 year after UDS. To assess the outcomes of these patients at 12-month follow-up. PATIENTS AND METHODS Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS. Women with USI underwent a Tension Free Vaginal Tape (Obturator) (TVT-O) procedure (Gynecare; Ethicon Inc., Somerville, NJ, USA), whereas women with DO ±/- USI were recommended 24-week antimuscarinic therapy. Follow-up was scheduled at 3 and 12 months. To define subjective outcomes, all patients completed the International Consultation on Incontinence Questionnaire - short form, the Patient Global Impression - Improvement and the Urinary Distress Inventory. Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the Urinary Distress Inventory and a response of 'much better' or 'very much better' on the Patient Global Impression - Improvement. RESULTS Of the 263 women with pure SUI, 74.5% had a urodynamic diagnosis of USI, 10.6% had DO, 8% had USI + DO and 6.8% had inconclusive UDS. At 12-month follow-up, 165/181 (91.6%) women in group 1 were considered cured post-TVT-O; in the other groups, 33/67 (49.2%) patients were considered cured simply as a result of taking antimuscarinics; 13 of these 67 patients required TVT-O. CONCLUSIONS UDS is able to show that several patients with symptoms of pure SUI present an underlying DO and do not require surgery, even 1 year after UDS. In these patients, antimuscarinic treatment appears to ensure a good rate of cure; thus, UDS could lead to the avoidance of several surgical procedures.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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183
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Svenningsen R, Staff AC, Schiøtz HA, Western K, Kulseng-Hanssen S. Long-term follow-up of the retropubic tension-free vaginal tape procedure. Int Urogynecol J 2013; 24:1271-8. [DOI: 10.1007/s00192-013-2058-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 01/19/2013] [Indexed: 11/30/2022]
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184
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Jiang YH, Wang CC, Chuang FC, Ke QS, Kuo HC. Positioning of a suburethral sling at the bladder neck is associated with a higher recurrence rate of stress urinary incontinence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:239-245. [PMID: 23341378 DOI: 10.7863/jum.2013.32.2.239] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the relationship between the suburethral sling position and the outcome of anti-incontinence surgery. METHODS From 1998 to 2010, the medical records of 153 consecutive women with stress urinary incontinence undergoing the pubovaginal sling procedure were retrospectively reviewed. All patients received preoperative and postoperative transrectal sonography of the bladder and urethra, and the suburethral sling position was used to compare the postoperative continence status and lower urinary tract symptoms. RESULTS The mean patient age ± SD was 60.7 ± 10.6 years (range, 34-85 years), and the mean follow-up was 66.3 ± 42.1 months (range, 6-149 months). The slings were located at the bladder neck in 18 patients (11.8%), proximal urethra in 81 (52.9%), middle urethra in 45 (29.4%), and distal urethra in 9 (5.9%). The overall rate of recurrent stress urinary incontinence was 24.2% (37 patients). Among the 153 patients, there was a significantly higher stress urinary incontinence recurrence rate in the bladder neck group (bladder neck, 50.0%; proximal urethra, 18.5%; middle urethra, 22.2%; and distal urethra, 33.3%; P = .037). De novo urge and voiding symptoms occurred in 19.0% and 20.3% of overall patients, respectively. There was no significant difference in either de novo urge or voiding symptoms among groups. CONCLUSIONS Positioning of the suburethral sling at the bladder neck appears to be associated with a higher stress urinary incontinence recurrence rate. Patients with slings located at the proximal and middle urethra had the best postsurgical continence rates. The suburethral sling position had no direct association with de novo urge or voiding symptoms.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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185
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Sun H, Fu G, Xie H. A MEMS accelerometer-based real-time motion-sensing module for urological diagnosis and treatment. J Med Eng Technol 2013; 37:127-34. [DOI: 10.3109/03091902.2012.753127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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186
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Cox A, Herschorn S, Lee L. Surgical management of female SUI: is there a gold standard? Nat Rev Urol 2013; 10:78-89. [PMID: 23318365 DOI: 10.1038/nrurol.2012.243] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Many surgical options exist for women with stress urinary incontinence (SUI). The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings--inserted via a retropubic or transobturator approach--have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications. Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery. Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. Based on the literature a new gold standard first-line surgical treatment for women with SUI is the synthetic midurethral sling inserted through a retropubic or transobturator approach [corrected].
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Affiliation(s)
- Ashley Cox
- Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Room MG 408, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
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187
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Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol 2013; 208:73.e1-7. [PMID: 23099189 PMCID: PMC3529743 DOI: 10.1016/j.ajog.2012.10.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 09/14/2012] [Accepted: 10/03/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the long-term risk of sling revision/removal after an initial sling and to assess indications (mesh erosion and urinary retention) and predictors of sling revision/removal. STUDY DESIGN Using a population-based cohort of commercially insured individuals, we identified women 18 years old or older who underwent a sling (Current Procedural Terminology code 57288) between 2001 and 2010 and any subsequent sling revision/removal (Current Procedural Terminology code 57287). We estimated the cumulative risk of revision/removal annually and evaluated predictors of sling revision/removal using Kaplan-Meier survival curves and Cox proportional hazards models, respectively. RESULTS We identified 188,454 eligible women who underwent an index sling. The 9 year cumulative risk of sling revision/removal was 3.7% (95% confidence interval [CI], 3.5-3.9). At 1 year, this risk was already 2.2% and then increased to 3.2% at 4 years before plateauing. With regard to the indication for the sling revision/removal, a greater proportion was due to mesh erosion compared with urinary retention, with a 9 year risk of 2.5% (95% CI, 2.3-2.6) for mesh erosion vs 1.3% (95% CI, 1.2-1.4) for urinary retention. Age had an effect on the revision/removal rates for both mesh erosion and urinary retention, with the higher risks among those aged 18-29 years. The risk of revision/removal for mesh erosion and urinary retention was also elevated among women who had a concomitant anterior or apical prolapse procedure. CONCLUSION In this population-based analysis, the 9 year risk of sling revision/removal was relatively low at 3.7%, with 60% of revisions/removals caused by mesh erosion.
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Affiliation(s)
- Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Women’s Health Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nazema Y. Siddiqui
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cindy L. Amundsen
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Jennifer M. Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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188
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Monoprosthesis for Simultaneous Correction of Stress Urinary Incontinence and Cystocele: A 3-Year follow-up. Urologia 2012; 79 Suppl 19:134-7. [DOI: 10.5301/ru.2012.9381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/20/2022]
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189
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Serati M, Bauer R, Cornu JN, Cattoni E, Braga A, Siesto G, Lizée D, Haab F, Torella M, Salvatore S. TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up. Eur Urol 2012; 63:872-8. [PMID: 23274106 DOI: 10.1016/j.eururo.2012.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce. OBJECTIVE To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. INTERVENTION TVT-O implantation without any associated procedure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes. RESULTS AND LIMITATIONS Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified. CONCLUSIONS TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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190
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Carr LK, Robert M, Kultgen PL, Herschorn S, Birch C, Murphy M, Chancellor MB. Autologous muscle derived cell therapy for stress urinary incontinence: a prospective, dose ranging study. J Urol 2012; 189:595-601. [PMID: 23260547 DOI: 10.1016/j.juro.2012.09.028] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/22/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE In this feasibility study we assessed the 12-month safety and potential efficacy of autologous muscle derived cells (Cook MyoSite Incorporated, Pittsburgh, Pennsylvania) as therapy for stress urinary incontinence. MATERIALS AND METHODS A total of 38 women in whom stress urinary incontinence had not improved with conservative therapy for 12 or more months underwent intrasphincter injection of low doses (1, 2, 4, 8 or 16 × 10(6)) or high doses (32, 64 or 128 × 10(6)) of autologous muscle derived cells, which were derived from biopsies of their quadriceps femoris. All patients could elect a second treatment of the same dose after 3-month followup. Assessments were made at 1, 3, 6 and 12 months after the last treatment. The primary end point was the incidence and severity of adverse events. In addition, changes in stress urinary incontinence severity were evaluated by pad test, diary of incontinence episodes and quality of life surveys. RESULTS Of the 38 patients 33 completed the study. Treatment related complications were limited to minor events such as pain/bruising at the biopsy and injection sites. Of patients who received 2 treatments of autologous muscle derived cells who were eligible for analysis, a higher percentage of those in the high dose vs the low dose group experienced a 50% or greater reduction in pad weight (88.9%, 8 of 9 vs 61.5%, 8 of 13), had a 50% or greater reduction in diary reported stress leaks (77.8%, 7 of 9 vs 53.3%, 8 of 15) and had 0 to 1 leaks during 3 days (88.9%, 8 of 9 vs 33.3%, 5 of 15) at final followup. CONCLUSIONS Injection of autologous muscle derived cells in a wide range of doses appears safe with no major treatment related adverse events reported. In addition, treatment with autologous muscle derived cells shows promise for relieving stress urinary incontinence symptoms and improving quality of life.
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Affiliation(s)
- Lesley K Carr
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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191
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Cañete P, Ortiz E, Domingo S, Cano A. Transobturator suburethral tape in the treatment of stress urinary incontinence: efficacy and quality of life after 5 year follow up. Maturitas 2012; 74:166-71. [PMID: 23218942 DOI: 10.1016/j.maturitas.2012.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 10/01/2012] [Accepted: 10/31/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Stress urinary incontinence (SUI) is a highly prevalent dysfunction in middle-aged and elderly women. One recent technique places a sub-urethral tape passed through the transobturator foramen. Efficacy and quality of life were assessed after five years of treatment with the transobturator technique in women suffering SUI. This evaluation followed a previous control at the first year post-intervention. STUDY DESIGN Sixty-three women were assessed five years after operation with the transobturator technique. Additionally, twenty-nine women of these women had undergone pelvic floor reconstruction due to different forms of genital prolapse. Quality of life (QoL) was assessed by the Urogenital Distress Inventory-6 (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7) tests. MAIN OUTCOME MEASURES Subjective and objective cure or improvement, complications, and changes in QoL. RESULTS Fifty women (79%) remained cured, as assessed by the cough test. Eighteen women (28%) reported urine leakage during physical activity. These objective and subjective data were worse than those reported at the one-year follow-up. De novo urge urinary incontinence was reported by 11 women or 17%. Nine of these women had undergone additional pelvic floor surgery. The QoL tests confirmed that cure or improvement was achieved in 78% (49) (UDI-6) and 79% (50) (IIQ-7) of the women. CONCLUSIONS The transobturator tape procedure resulted in acceptable rates of efficacy after five years. Moreover, QoL tests showed cure or improvement in almost four of five women. Nonetheless, women should be informed of the risk of de novo urinary urgency incontinence and the progressive loss of efficacy with time.
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Leone Roberti Maggiore U, Alessandri F, Medica M, Gabelli M, Venturini PL, Ferrero S. Periurethral Injection of Polyacrylamide Hydrogel for the Treatment of Stress Urinary Incontinence: The Impact on Female Sexual Function. J Sex Med 2012. [DOI: 10.1111/j.1743-6109.2012.02955.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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193
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Albo ME, Litman HJ, Richter HE, Lemack GE, Sirls LT, Chai TC, Norton P, Kraus SR, Zyczynski H, Kenton K, Gormley EA, Kusek JW. Treatment success of retropubic and transobturator mid urethral slings at 24 months. J Urol 2012; 188:2281-7. [PMID: 23083653 PMCID: PMC4367868 DOI: 10.1016/j.juro.2012.07.103] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Longer term comparative efficacy information regarding transobturator and retropubic mid urethral slings is needed. We report 24-month continence rates, complications and symptom outcomes from a randomized equivalence trial. MATERIALS AND METHODS Primary outcomes were objective (negative stress test, negative pad test and no re-treatment for stress urinary incontinence) and subjective (no self-report of stress urinary incontinence symptoms, no leakage episodes on 3-day bladder diary and no re-treatment for stress urinary incontinence) success at 24 months. The predetermined equivalence margin was ± 12%. RESULTS Of 597 randomized participants 516 (86.4%) were assessed. Objective success rates for retropubic and transobturator mid urethral slings were 77.3% and 72.3%, respectively (95% CI for difference of 5.1% was -2.0, 12.1), and subjective success rates were 55.7% and 48.3%, respectively (CI for difference of 7.4% was -0.7, 15.5). Neither objective nor subjective success rates met the prespecified criteria for equivalence. Patient satisfaction (retropubic 86.3% vs transobturator 88.1%, p = 0.58), frequency of de novo urgency incontinence (retropubic 0% vs transobturator 0.3%, p = 0.99) and occurrence of mesh exposure (retropubic 4.4% vs transobturator 2.7%, p = 0.26) were not significantly different. The retropubic mid urethral sling group had higher rates of voiding dysfunction requiring surgery (3.0% vs 0%, p = 0.002) and urinary tract infections (17.1% vs 10.7%, p = 0.025), whereas the transobturator group had more neurological symptoms (9.7% vs 5.4%, p = 0.045). CONCLUSIONS Objective success rates met the criteria for equivalence at 12 months but no longer met these criteria at 24 months. Subjective success rates remained inconclusive for equivalence. Patient satisfaction remained high and symptom severity remained markedly improved. Continued surveillance is important in women undergoing mid urethral sling surgery.
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Affiliation(s)
- Michael E Albo
- University of California, San Diego, La Jolla, California, USA.
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Dursun M, Otunctemur A, Ozbek E, Cakir SS, Polat EC. Impact of the transobturator tape procedure on sexual function in women with stress urinary incontinence. J Obstet Gynaecol Res 2012; 39:831-5. [DOI: 10.1111/j.1447-0756.2012.02048.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 08/30/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Dursun
- Department of Urology; Okmeydani Training and Research Hospital; Istanbul
| | - Alper Otunctemur
- Department of Urology; Okmeydani Training and Research Hospital; Istanbul
| | - Emin Ozbek
- Department of Urology; Okmeydani Training and Research Hospital; Istanbul
| | | | - Emre Can Polat
- Department of Urology; Balikligol State Hospital; Sanliurfa; Turkey
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195
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Transobturator vaginal tape for the treatment of stress urinary incontinence in elderly women without concomitant pelvic organ prolapse: is it effective and safe? Eur J Obstet Gynecol Reprod Biol 2012; 166:107-10. [PMID: 23164504 DOI: 10.1016/j.ejogrb.2012.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/16/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women. STUDY DESIGN Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥ 70 years old) were included in group 1, while younger women (< 70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups. RESULTS During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15-41) months for the younger and 25 (IQR 18-40) months for older patients (p>0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p=0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p=0.44). CONCLUSIONS TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population.
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Wein AJ. Re: Transobturator Versus Retropubic Synthetic Slings: Comparative Efficacy and Safety. J Urol 2012; 188:1844-5. [DOI: 10.1016/j.juro.2012.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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197
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Abdel-fattah M, Mostafa A, Familusi A, Ramsay I, N'Dow J. Prospective Randomised Controlled Trial of Transobturator Tapes in Management of Urodynamic Stress Incontinence in Women: 3-Year Outcomes from the Evaluation of Transobturator Tapes Study. Eur Urol 2012; 62:843-51. [DOI: 10.1016/j.eururo.2012.04.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022]
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198
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Winters JC. Surgical management of stress urinary incontinence: A rational approach to treatment selection. Can Urol Assoc J 2012; 6:S118-9. [PMID: 23092770 DOI: 10.5489/cuaj.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There are a number of operative approaches to correct stress urinary incontinence (SUI). There is clearly not one procedure that "fits all." This review provides a summary of key available data comparing the various interventions. These findings are then incorporated into an algorithm, which attempts to outline a rational approach to select the most appropriate procedures in women seeking surgical treatment of SUI.
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Affiliation(s)
- J Christian Winters
- H. Eustis Reily Professor of Urology and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA
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199
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Zoorob D, Karram M. Role of autologous bladder-neck slings: a urogynecology perspective. Urol Clin North Am 2012; 39:311-6. [PMID: 22877713 DOI: 10.1016/j.ucl.2012.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The concept of the autologous pubovaginal sling involves supporting the proximal urethra and bladder neck with a piece of graft material, achieving continence either by providing a direct compressive force on the urethra/bladder outlet or by reestablishing a reinforcing platform or hammock against which the urethra is compressed during transmission of increased abdominal pressure. Pubovaginal slings using a biological sling material (whether autologous, allograft, or xenograft) can be used successfully to manage primary or recurrent stress incontinence. This article addresses the indications for the use of an autologous bladder-neck sling, describes the surgical techniques, and discusses outcomes and technical considerations.
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Affiliation(s)
- Dani Zoorob
- Department of Obstetrics and Gynecology, The Christ Hospital/University of Cincinnati, Cincinnati, OH 45267, USA
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Bettez M, Tu LM, Carlson K, Corcos J, Gajewski J, Jolivet M, Bailly G. 2012 update: guidelines for adult urinary incontinence collaborative consensus document for the canadian urological association. Can Urol Assoc J 2012; 6:354-63. [PMID: 23093627 PMCID: PMC3478335 DOI: 10.5489/cuaj.12248] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mathieu Bettez
- Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC
| | - Le Mai Tu
- Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC
| | - Kevin Carlson
- Department of Surgery, Division of Urology, University of Calgary, Calgary, AB
| | - Jacques Corcos
- Department of Surgery, Division of Urology, McGill University, Montreal, QC
| | - Jerzy Gajewski
- Department of Urology, Dalhousie University, Halifax, NS
| | - Martine Jolivet
- Department of Surgery, Division of Urology, Université de Montréal, Montreal, QC
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS
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