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Matthews CA, Rardin CR, Sokol A, Iglesia C, Collins S, Ferrando C, Winkler H, Kenton K, Geynisman-Tan J, Gutman RE. A randomized trial of retropubic vs single-incision sling among patients undergoing vaginal prolapse repair. Am J Obstet Gynecol 2024; 231:261.e1-261.e10. [PMID: 38705225 DOI: 10.1016/j.ajog.2024.04.036] [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: 01/08/2024] [Revised: 03/27/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The choice of midurethral sling type may impact efficacy and complications in women undergoing transvaginal native tissue repair of pelvic organ prolapse. OBJECTIVE The primary aim was to determine if the single-incision sling is noninferior to retropubic sling for the management of stress urinary incontinence among patients undergoing reconstructive or obliterative native tissue vaginal repair. The secondary aims were to compare adverse events and surgeon ease of use with sling assignment. STUDY DESIGN A multicenter, noninferiority, randomized trial of women with ≥ stage II pelvic organ prolapse and objectively confirmed stress urinary incontinence undergoing reconstructive or obliterative vaginal repair was performed. Women were randomized to concomitant single-incision (Altis sling, Coloplast Minneapolis, MN) with suprapubic sham incisions or retropubic slings. The primary dichotomous outcome was abnormal lower urinary tract function within 12 months postsurgery, defined as bothersome stress urinary incontinence symptoms (>1 Pelvic Floor Distress Inventory question no. 17); retreatment for stress urinary incontinence or treatment for urinary retention. Secondary outcomes were adverse events, Patient Global Impression of Improvement of bladder function, and surgeon ease of use (1, worst; 10, best). All subjects completed validated questionnaires and underwent a Pelvic Organ Prolapse Quantification, cough stress test, and postvoid residual preoperatively, at 6 weeks and 12 months postoperatively. Assuming a subjective cure rate for retropubic of 82%, 80% power, and 1-sided 5% significance level, we estimated that 127 patients in each arm were needed to declare noninferiority of the single-incision sling if the upper bound of the 95% confidence interval for the between-group difference per protocol in abnormal bladder function was <12%. Assuming a 10% loss to follow-up, the total enrollment goal was 280. RESULTS Between December 2018 and January 2023, 280 subjects were enrolled across 7 sites, and 255 were randomized: 126 were for single-incision, and 129 were for retropubic sling. There were no preoperative or operative characteristic differences between groups. Overall, 81% had reconstructive, and 19% had obliterative native tissue repairs. The primary outcome, abnormal lower urinary tract function at 12 months, occurred in 29 (25%) of single-incision vs 24 (20%) of the retropubic sling group (risk difference, 0.04472 [95% confidence interval, -0.03 to 0.1133]; P=.001 for noninferiority). Bothersome stress urinary incontinence occurred in 20% vs 17% (P=.27) and was retreated in 4% vs 2% (P=.44) of single-incision vs retropubic groups, respectively. Adverse events were reported in 24 (16%) of single-incision vs 14 (9%) of the retropubic group (95% confidence interval, 0.95-3.29; P=.70) and included de novo or worsening urgency incontinence symptoms, urinary tract infection, mesh exposure, need for prolonged catheter drainage, and de novo pain, without differences between groups. Patient Global Impression of Improvement (very satisfied and satisfied) was 71% vs 67% (P=.43), and median surgeon ease of sling use was 8 (7-10) vs 9 (8-10), P=.03 in single-incision vs retropubic, respectively. CONCLUSION For women undergoing vaginal repair, single-incision was noninferior to retropubic sling for stress urinary incontinence symptoms, and complications, including treatment for urinary retention, did not differ.
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Affiliation(s)
| | - Charles R Rardin
- Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island Providence, RI
| | - Andrew Sokol
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Georgetown University, Washington DC
| | - Cheryl Iglesia
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Georgetown University, Washington DC
| | - Sarah Collins
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | | | - Harvey Winkler
- Department of Obstetrics and Gynecology, Hofstra University/Northwell Health, Hempstead, NY
| | - Kimberly Kenton
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Robert E Gutman
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Georgetown University, Washington DC
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Lee CL, Park JM, Lee JY, Yang SW, Na HS, Lee J, Jung S, Shin JH. A Novel Incisionless Disposable Vaginal Device for Female Stress Urinary Incontinence: Efficacy and Quality of Life. Int Neurourol J 2023; 27:S40-48. [PMID: 37280759 DOI: 10.5213/inj.2346092.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device, designed for patients suffering from stress urinary incontinence. METHODS A prospective, multicenter, single-arm clinical trial was carried out, involving women diagnosed with stress urinary incontinence who used a self-inserted, disposable intravaginal pessary device. Comparisons were made between the results of the 20-minute pad-weight gain (PWG) test at baseline and visit 3, where the device was applied. After 1 week of device usage, compliance, satisfaction, the sensation of a foreign body, and adverse events were assessed. RESULTS Out of 45 participants, 39 completed the trial and expressed satisfaction within the modified intention-to-treat group. The average 20-minute PWG of participants was 17.2±33.6 g at baseline and significantly dropped to 5.3±16.2 g at visit 3 with device application. A total of 87.2% of participants exhibited a reduction ratio of PWG by 50% or more, surpassing the clinical trial success benchmark of 76%. The mean compliance was recorded as 76.6%±26.6%, the average visual analogue scale score for patient satisfaction was 6.4±2.6, and the sensation of a foreign body, measured on a 5-point Likert scale, was 3.1±1.2 after 1 week of device use. No serious adverse events were reported; there was 1 instance of microscopic hematuria and 2 cases of pyuria, all of which recovered. CONCLUSION The investigated device demonstrated significant clinical effectiveness and safety for patients with stress urinary incontinence. It was easy to use, showing favorable patient compliance. We propose that these disposable intravaginal pessaries could potentially be an alternative treatment for patients with stress urinary incontinence who are seeking nonsurgical options or are unable to undergo surgery. Trial Registration: The study was registered as a clinical trial (KCT0008369).
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Affiliation(s)
- Chung Lyul Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Jong Mok Park
- Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Ji Yong Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Woo Yang
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Hyun Seok Na
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Jaegeun Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Sunkyung Jung
- Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Ju Hyun Shin
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
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Abdel-Fattah M, Cooper D, Davidson T, Kilonzo M, Boyers D, Bhal K, McDonald A, Wardle J, N'Dow J, MacLennan G, Norrie J. Single-incision mini-slings versus standard synthetic mid-urethral slings for surgical treatment of stress urinary incontinence in women: The SIMS RCT. Health Technol Assess 2022; 26:1-190. [PMID: 36520097 PMCID: PMC9761550 DOI: 10.3310/btsa6148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Stress urinary incontinence is the most common type of urinary incontinence in premenopausal women. Until recently, synthetic mid-urethral slings (mesh/tape) were the standard surgical treatment, if conservative management failed. Adjustable anchored single-incision mini-slings are newer, use less mesh and may reduce perioperative morbidity, but it is unclear how their success rates and safety compare with those of standard tension-free mid-urethral slings. OBJECTIVE The objective was to compare tension-free standard mid-urethral slings with adjustable anchored single-incision mini-slings among women with stress urinary incontinence requiring surgical intervention, in terms of patient-reported effectiveness, health-related quality of life, safety and cost-effectiveness. DESIGN This was a pragmatic non-inferiority randomised controlled trial. Allocation was by remote web-based randomisation (1 : 1 ratio). SETTING The trial was set in 21 UK hospitals. PARTICIPANTS Participants were women aged ≥ 18 years with predominant stress urinary incontinence, undergoing a mid-urethral sling procedure. INTERVENTIONS Single-incision mini-slings, compared with standard mid-urethral slings. MAIN OUTCOME MEASURES The primary outcome was patient-reported success rates on the Patient Global Impression of Improvement scale at 15 months post randomisation (≈ 1 year post surgery), with success defined as outcomes of 'very much improved' or 'much improved'. The primary economic outcome was incremental cost per quality-adjusted life-year gained. Secondary outcomes were adverse events, impact on other urinary symptoms, quality of life and sexual function. RESULTS A total of 600 participants were randomised. At 15 months post randomisation, adjustable anchored single-incision mini-slings were non-inferior to tension-free standard mid-urethral slings at the 10% margin for the primary outcome [single-incision mini-sling 79% (212/268) vs. standard mid-urethral sling 76% (189/250), risk difference 4.6, 95% confidence interval -2.7 to 11.8; p non-inferiority < 0.001]. Similarly, at 3 years' follow-up, patient-reported success rates in the single-incision mini-sling group were non-inferior to those of the standard mid-urethral sling group at the 10% margin [single-incision mini-sling 72% (177/246) vs. standard mid-urethral sling 67% (157/235), risk difference 5.7, 95% confidence interval -1.3 to 12.8; p non-inferiority < 0.001]. Tape/mesh exposure rates were higher for single-incision mini-sling participants, with 3.3% (9/276) [compared with 1.9% (5/261) in the standard mid-urethral sling group] reporting tape exposure over the 3 years of follow-up. The rate of groin/thigh pain was slightly higher in the single-incision mini-sling group at 15 months [single-incision mini-sling 15% (41/276) vs. standard mid-urethral sling 12% (31/261), risk difference 3.0%, 95% confidence interval -1.1% to 7.1%]; however, by 3 years, the rate of pain was slightly higher among the standard mid-urethral sling participants [single-incision mini-sling 14% (39/276) vs. standard mid-urethral sling 15% (39/261), risk difference -0.8, 95% confidence interval -4.1 to 2.5]. At the 3-year follow-up, quality of life and sexual function outcomes were similar in both groups: for the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life, the mean difference in scores was -1.1 (95% confidence interval -3.1 to 0.8; p = 0.24), and for the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised, it was 0 (95% confidence interval -0.1, 0.1; p = 0.92). However, more women in the single-incision mini-sling group reported dyspareunia [12% (17/145), compared with 4.8% (7/145) in the standard mid-urethral sling group, risk difference 7.0%, 95% confidence interval 1.9% to 12.1%]. The base-case economics results showed no difference in costs (-£6, 95% confidence interval -£228 to £208) or quality-adjusted life-years (0.005, 95% confidence interval -0.068 to 0.073) between the groups. There is a 56% probability that single-incision mini-slings will be considered cost-effective at the £20,000 willingness-to-pay threshold value for a quality-adjusted life-year. LIMITATIONS Follow-up data beyond 3 years post randomisation are not available to inform longer-term safety and cost-effectiveness. CONCLUSIONS Single-incision mini-slings were non-inferior to standard mid-urethral slings in patient-reported success rates at up to 3 years' follow-up. FUTURE WORK Success rates, adverse events, retreatment rates, symptoms, and quality-of-life scores at 10 years' follow-up will help inform long-term effectiveness. TRIAL REGISTRATION This trial was registered as ISRCTN93264234. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mohamed Abdel-Fattah
- Aberdeen Centre For Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Tracey Davidson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kiron Bhal
- Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Alison McDonald
- Aberdeen Centre For Women's Health Research, University of Aberdeen, Aberdeen, UK
| | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Aberdeen Centre For Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
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Abdel-Fattah M, Cooper D, Davidson T, Kilonzo M, Hossain M, Boyers D, Bhal K, Wardle J, N'Dow J, MacLennan G, Norrie J. Single-Incision Mini-Slings for Stress Urinary Incontinence in Women. N Engl J Med 2022; 386:1230-1243. [PMID: 35353961 DOI: 10.1056/nejmoa2111815] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Until recently, synthetic midurethral slings (made of mesh or tape) were the standard surgical treatment worldwide for female stress urinary incontinence, if conservative management failed. Data comparing the effectiveness and safety of newer single-incision mini-slings with those of standard midurethral slings are limited. METHODS We performed a pragmatic, noninferiority, randomized trial comparing mini-slings with midurethral slings among women at 21 U.K. hospitals during 36 months of follow-up. The primary outcome was patient-reported success (defined as a response of very much or much improved on the Patient Global Impression of Improvement questionnaire) at 15 months after randomization (approximately 1 year after surgery). The noninferiority margin was 10 percentage points. RESULTS A total of 298 women were assigned to receive mini-slings and 298 were assigned to receive midurethral slings. At 15 months, success was reported by 212 of 268 patients (79.1%) in the mini-sling group and by 189 of 250 patients (75.6%) in the midurethral-sling group (adjusted risk difference, 4.6 percentage points; 95% confidence interval [CI], -2.7 to 11.8; P<0.001 for noninferiority). At the 36-month follow-up, success was reported by 177 of 246 patients (72.0%) and by 157 of 235 patients (66.8%) in the respective groups (adjusted risk difference, 5.7 percentage points; 95% CI, -1.3 to 12.8). At 36 months, the percentage of patients with groin or thigh pain was 14.1% with mini-slings and 14.9% with midurethral slings. Over the 36-month follow-up period, the percentage of patients with tape or mesh exposure was 3.3% with mini-slings and 1.9% with midurethral slings, and the percentage who underwent further surgery for stress urinary incontinence was 2.5% and 1.1%, respectively. Outcomes with respect to quality of life and sexual function were similar in the two groups, with the exception of dyspareunia; among 290 women responding to a validated questionnaire, dyspareunia was reported by 11.7% in the mini-sling group and 4.8% in the midurethral-sling group. CONCLUSIONS Single-incision mini-slings were noninferior to standard midurethral slings with respect to patient-reported success at 15 months, and the percentage of patients reporting success remained similar in the two groups at the 36-month follow-up. (Funded by the National Institute for Health Research.).
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Affiliation(s)
- Mohamed Abdel-Fattah
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - David Cooper
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Tracey Davidson
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Mary Kilonzo
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Md Hossain
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Dwayne Boyers
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Kiron Bhal
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Judith Wardle
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - James N'Dow
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - Graeme MacLennan
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
| | - John Norrie
- From the University of Aberdeen, Aberdeen (M.A.-F., D.C., T.D., M.K., M.H., D.B., J. N'Dow, G.M.), University Hospital of Wales, Cardiff (K.B.), Oxford (J.W.), and the University of Edinburgh, Edinburgh (J. Norrie) - all in the United Kingdom
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Durante J, Manassero F, Fidecicchi T, Tognarelli A, Di Vico T, Faviana P, Selli C. Autologous fascial slings remain viable at long-term follow-up: a post cystectomy case report. BMC Urol 2021; 21:122. [PMID: 34496811 PMCID: PMC8424806 DOI: 10.1186/s12894-021-00884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Autologous fascial slings (AFS) have been used for a very long time in the treatment of female stress urinary incontinence, but the introduction of synthetic mesh slings placed either retropubicallyor trans-obturator has decreased the need to harvest the autologous rectus muscle fascia, thus reducing invasiveness and operative time. However AFS are still indicated in complicated cases and re-interventions, and the FDA has underlined safety concerns over the use of surgical meshes for the transvaginal repair of prolapsed pelvic organs. CASE PRESENTATION A 76-year-old woman with muscle-invasivebladder cancer underwent radical cystectomy 16 years after retropubic positioning of an autologous rectus muscle fascial sling for SUI, with complete symptom resolution. The sling was easily identified and removed en bloc with the bladder and urethra, providing an opportunity to histologicallyevaluate the autologous fascial graft after its long permanence in the new position. Histopathological examination demonstrated increased fibroblastic proliferation and formation of capillaries. A slight separation and an increased waviness of the connective fibers were both evident. An increased vascularity was also apparent, including transverse vessels, with clusters of vessels. A relative inflammatory reaction was present in over 300 cells/10 HPF. All these characteristics indicated viable connective tissue. CONCLUSIONS AFS remain a valuable surgical option for both primary and recurrent SUI in women, showing high cure rates and low complications in the long-term. The present case, to the best of our knowledge, presents the longest follow-up period of an autologous rectus muscle fascia placed retropubically and its histological evaluation documents characteristics which support its mechanical strength and viability.
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Affiliation(s)
- Jacopo Durante
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy.
| | - Francesca Manassero
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Tiziana Fidecicchi
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Alessio Tognarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Tommaso Di Vico
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Pinuccia Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Section of Pathology, University of Pisa, via Roma 67, 56124, Pisa, Italy
| | - Cesare Selli
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
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Abrar S, Razzak L, Mohsin R. The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country. Pak J Med Sci 2021; 37:1359-1364. [PMID: 34475912 PMCID: PMC8377912 DOI: 10.12669/pjms.37.5.4017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI). METHODS We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6). RESULTS Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure. CONCLUSIONS All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.
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Affiliation(s)
- Saida Abrar
- Dr. Saida Abrar Clinical Fellow Urogynecology and Pelvic Reconstructive Surgery, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Lubna Razzak
- Dr. Lubna Razzak Clinical Fellow Urogynecology and Pelvic Reconstructive Surgery, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Raheela Mohsin
- Dr. Raheela Mohsin Rizvi Associate Professor Urogynecology, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
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Kaufmann A. [Therapeutic options in female stress urinary incontinence]. Aktuelle Urol 2021; 52:245-254. [PMID: 33873214 DOI: 10.1055/a-1439-9628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Stress urinary incontinence in female patients is characterised by loss of urine without the need to urinate. Causes are manifold and require a good knowledge of the pelvic floor structures and the functionality of the bladder's occlusion system. Before any treatment can be initiated, differentiated diagnostic investigation must uncover the causes in order to be able to show incontinent women the ideal therapeutic options. In addition to conservative treatment strategies, there are several surgical alternatives available that can be used depending on the functional and/or anatomical deficit. Surgical correction produces good results, although a minor rate of possible complications must be accepted.
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Affiliation(s)
- Albert Kaufmann
- Kliniken Maria Hilf GmbH, Zentrum für Kontinenz und Neuro-Urologie, Mönchengladbach
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Moosavi SY, Samad-Soltani T, Hajebrahimi S, Sadeghi-Ghyassi F, Pashazadeh F, Abolhasanpour N. Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: A systematic review. Turk J Urol 2020; 46:427-435. [PMID: 32976089 DOI: 10.5152/tud.2020.20291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is a common problem in women that affects their quality of life. According to the current evidence, 15%-50% of severe pelvic organ prolapse (POP) surgeries lead to de novo urinary incontinence (UI). This study aimed at determining the risk factors and characteristics of de novo SUI after POP surgeries in a systematic review. MATERIAL AND METHODS We conducted a systematic search of articles in English related to the risk of UI after POP surgery published until December 2019 in the selected bibliographic databases, including PubMed, EMBASE, Scopus, Cochrane Library, and ProQuest. RESULTS The initial search resulted in 2,363 studies, and after reviewing the titles and abstracts, 146 studies were identified. Moreover, 2 independent reviewers, using the Joanna Briggs Institute checklists, evaluated the risk of biases in the selected studies. Finally, 40 studies met the inclusion criteria. The most important predictors of UI after POP surgery were positive pessary testing, age >50 years, and maximum urethral closure pressure (MUCP) <60 cmH2O. CONCLUSION Positive pessary testing, older age, and low MUCP were the most important risk factors for de novo incontinence after POP surgeries.
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Affiliation(s)
- Seyyde Yalda Moosavi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.,Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadeghi-Ghyassi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Abolhasanpour
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Yıldız G, Batur AF, Akand M, Kılıç Ö, Şahin MO. Comparison of Two Single-Incision Mini-Slings for the Treatment of Incontinence. Med Princ Pract 2020; 30:85-91. [PMID: 32911466 PMCID: PMC7923843 DOI: 10.1159/000511465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study aimed to compare the safety and efficacy of 2 single-incision mini-sling (SIMS) systems with different designs of anchoring mechanism. METHODS The records of patients who have been operated for the treatment of female stress urinary incontinence (SUI) with 2 different SIMS systems were retrospectively evaluated. Patient characteristics, physical examination results, and quality of life (QoL) questionnaires were used to evaluate the patients. Primary efficacy endpoints were the cure and failure rates. Secondary efficacy endpoints were complications and differences in QoL questionnaires. RESULTS Eighty-three patients from group 1 (Ophira SIMS system) and 77 patients from group 2 (Gallini SIMS system) were evaluated. There was no significant difference between the 2 groups regarding patient characteristics. The objective cure rates were found to be 83.1 and 79.2% in group 1 and group 2, respectively (p = 0.09). Mesh-related complications, such as anchor displacement, bladder erosion, vaginal erosion, and groin pain, were more common in group 1. No severe complications were observed. For both groups, a significant improvement in all scores of QoL questionnaires was observed after surgery; however, the differences between 2 groups were not significant. CONCLUSIONS The present study showed that the treatment of female SUI with 2 different SIMS systems had similar efficacy, complication rates, and scores in QoL questionnaires.
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Affiliation(s)
- Guner Yıldız
- Urology Clinic, Health Sciences University Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
| | - Ali Furkan Batur
- Department of Urology, Selçuk University, School of Medicine, Konya, Turkey,
| | - Murat Akand
- Department of Urology, Selçuk University, School of Medicine, Konya, Turkey
| | - Özcan Kılıç
- Department of Urology, Selçuk University, School of Medicine, Konya, Turkey
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10
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Sussman RD, Syan R, Brucker BM. Guideline of guidelines: urinary incontinence in women. BJU Int 2020; 125:638-655. [DOI: 10.1111/bju.14927] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Rachael D. Sussman
- Department of Urology; MedStar Georgetown University Hospital; Washington DC USA
| | - Raveen Syan
- Department of Urology; Stanford School of Medicine; Stanford CA USA
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11
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Long-term Risk of Reoperation After Synthetic Mesh Midurethral Sling Surgery for Stress Urinary Incontinence. Obstet Gynecol 2019; 134:1047-1055. [DOI: 10.1097/aog.0000000000003526] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Current Role of Urethrolysis and Partial Excision in Patients Seeking Revision of Anti-Incontinence Sling. Female Pelvic Med Reconstr Surg 2018; 25:409-414. [DOI: 10.1097/spv.0000000000000596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Complications and their treatment after midurethral tape implantation using retropubic and transobturator approaches for treatment of female stress urinary incontinence. Wideochir Inne Tech Maloinwazyjne 2018; 13:501-506. [PMID: 30524621 PMCID: PMC6280087 DOI: 10.5114/wiitm.2018.75871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Midurethral tape implantation procedures currently are the first-line treatment for female stress urinary incontinence (SUI). Aim To estimate the most common intraoperative and postoperative complications and their treatment methods after midurethral tape implantation using retropubic (tension-free vaginal tape – TVT) and transobturator (TOT) approaches for the treatment of female SUI. Material and methods A retrospective descriptive study was performed on 367 women operated on due to SUI in the period from 2004 to 2015. The SUI diagnosis was confirmed by clinical history and physical examination. According to the surgical technique that was chosen for SUI treatment, all the patients were divided into two groups: the TVT group (n = 112) and the TOT group (n = 255). Results In total, in 31 (8.45%) of 367 patients complications were observed after midurethral tape implantation. In the TVT group 18 (16.07%) of 112 patients experienced surgery-related complications compared to 13 (5.1%) of 255 patients in the TOT group (p = 0.0005). The most common intraoperative complication in the TVT group was bladder perforation. In the TOT group we had only occasional intraoperative complications. Acute urinary retention was the most common postoperative complication in both groups. It was observed in 13 (11.6%) patients in the TVT group and in 5 (1.96%) patients in the TOT group. Conclusions The advantage of midurethral tape implantation using the TOT technique is that it is associated with lower incidence of intraoperative and postoperative complications compared to TVT. The most common complication in our series was acute postoperative urinary retention, which usually required an additional tape loosening procedure.
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Associations Between Childbirth and Urinary Incontinence After Midurethral Sling Surgery. Obstet Gynecol 2018; 131:297-303. [DOI: 10.1097/aog.0000000000002445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Sender Herschorn
- Division of Urology University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Drain A, Khan A, Ohmann EL, Brucker BM, Smilen S, Rosenblum N, Nitti VW. Use of Concomitant Stress Incontinence Surgery at Time of Pelvic Organ Prolapse Surgery Since Release of the 2011 Notification on Serious Complications Associated with Transvaginal Mesh. J Urol 2017; 197:1092-1098. [DOI: 10.1016/j.juro.2016.11.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alice Drain
- New York University Langone Medical Center, New York, New York
| | - Aqsa Khan
- New York University Langone Medical Center, New York, New York
| | - Erin L. Ohmann
- New York University Langone Medical Center, New York, New York
| | | | - Scott Smilen
- New York University Langone Medical Center, New York, New York
| | - Nirit Rosenblum
- New York University Langone Medical Center, New York, New York
| | - Victor W. Nitti
- New York University Langone Medical Center, New York, New York
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Ulrich D, Bjelic-Radisic V, Höllein A, Trutnovsky G, Tamussino K, Aigmüller T. Quality of life and objective outcome assessment in women with tape division after surgery for stress urinary incontinence. PLoS One 2017; 12:e0174628. [PMID: 28346541 PMCID: PMC5367714 DOI: 10.1371/journal.pone.0174628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/13/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midurethral tapes may cause long-term complications such as voiding dysfunction, groin pain, de novo urgency or mesh erosion, which necessitate a reoperation. There is a paucity of data regarding health related quality of life in patients undergoing tape removal. The aim of the study was to evaluate quality of life (QoL) and objective outcome after midurethral tape division or excision. METHODS All patients who underwent a midurethral tape division for voiding difficulties, pain or therapy resistant de novo overactive bladder between 1999 and 2014 were invited for follow-up. A control group with a suburethral tape without division was established in a 1:2 ratio and matched for age, tape used and year of tape insertion. Patients completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire, Female Sexual Function Index Questionnaire and the Patient Global Impression of Improvement score. RESULTS Tape division or excision was performed in 32 women. Overall, 15 (60%) of 25 women who were alive were available for clinical examination and completed the questionnaires. Tape division was performed for voiding dysfunction (n = 7), overactive bladder (n = 2), mesh extrusion (n = 3) and ongoing pain (n = 3). Median time to tape division/excision was 10 months. Three women in the tape division group had undergone reoperation for stress urinary incontinence (SUI). At a median follow-up of 11 years (IQR 9-13) subjective SUI rate was 53% (8/15 women) in the tape division group and 17% (5/30) in the control group (p = 0.016), with no significant differences in objective SUI rates between groups. With regard to quality of life, the study group had significantly worse scores in the SUI related domains role limitation, physical limitation, severity measures and social limitations (KHQ) compared to the control group. CONCLUSIONS Women needing tape division or excision have lower SUI related QoL scores compared to controls mostly because of higher subjective SUI rates.
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Affiliation(s)
- Daniela Ulrich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Anna Höllein
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Gerda Trutnovsky
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Thomas Aigmüller
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Kokanalı MK, Cavkaytar S, Kokanalı D, Aksakal O, Doganay M. A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence*. J OBSTET GYNAECOL 2016; 36:1080-1085. [DOI: 10.1080/01443615.2016.1209169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ten-Year Followup after Tension-Free Vaginal Tape-Obturator Procedure for Stress Urinary Incontinence. J Urol 2016; 196:1201-6. [DOI: 10.1016/j.juro.2016.05.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
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20
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Ulrich D, Bjelic-Radisic V, Grabner K, Avian A, Trutnovsky G, Tamussino K, Aigmüller T. Objective outcome and quality-of-life assessment in women with repeat incontinence surgery. Neurourol Urodyn 2016; 36:1543-1549. [PMID: 27672734 DOI: 10.1002/nau.23144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/02/2016] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate subjective and objective outcome after repeat surgery for stress urinary incontinence (SUI). METHODS Patients who underwent a midurethral tape after failed Burch colposuspension or failed midurethal tape between 1999 and 2014 were invited for follow-up. Urogynecological examination and urodynamics was performed, and objective cure was defined as a negative cough stress test; subjective cure was defined as negotiation of SUI symptoms. Quality-of-life (QoL), sexual health, and subjective success was assessed with the King's Health Questionnaire, Incontinence Outcome Questionnaire, Female Sexual Function Index, and the Patient Global Impression of Improvement (PGI-I) score. RESULTS Overall 52 women underwent repeat incontinence surgery. Out of the 44 women still alive, 33 (75%) were available for follow-up. All 33 women completed the questionnaires; 23 women (70%) attended the clinic and also had an urogynecological examination. At a median follow-up of 11 years, subjective cure was 67% (22/33), objective cure was 65% (16/23), and subjective success according to PGI-I was 78% (18/23), with no significant differences between groups. No erosions of suture or tape material into the bladder, urethra, or vagina were seen. Two women had received a third anti-incontinence operation with TVT after failed tape after failed Burch, and were continent at follow-up. Two women with tape after colposuspension required division of the tape and both were continent at the time of follow-up. With regard to QoL and sexual health, no significant differences were seen for most domains. CONCLUSIONS Midurethral tapes are an option for women with recurrent SUI after previous colposuspension or midurethral tape.
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Affiliation(s)
- Daniela Ulrich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Katrin Grabner
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Department of Medical Statistics, Medical University of Graz, Graz, Austria
| | - Gerda Trutnovsky
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Thomas Aigmüller
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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A unique case of suburethral sling mesh migration to the cervix. Int Urogynecol J 2016; 27:1775-1776. [PMID: 27631822 DOI: 10.1007/s00192-016-3110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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Parden AM, Tang Y, Szychowski J, Richter HE. Characterization of Lower Urinary Tract Symptoms Before and After Midurethral Sling Revision. J Minim Invasive Gynecol 2016; 23:979-85. [DOI: 10.1016/j.jmig.2016.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 12/22/2022]
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Carmel ME, Deng DY, Greenwell TJ, Zimmern PE. Definition of Success after Surgery for Female Stress Incontinence or Voiding Dysfunction: An Attempt at Standardization. Eur Urol Focus 2016; 2:231-237. [DOI: 10.1016/j.euf.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/24/2016] [Accepted: 03/14/2016] [Indexed: 11/24/2022]
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Khatri G, Carmel ME, Bailey AA, Foreman MR, Brewington CC, Zimmern PE, Pedrosa I. Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction. Radiographics 2016; 36:1233-56. [DOI: 10.1148/rg.2016150215] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Al-Zahrani AA, Gajewski J. Long-term patient satisfaction after retropubic and transobturator mid-urethral slings for female stress urinary incontinence. J Obstet Gynaecol Res 2016; 42:1180-5. [DOI: 10.1111/jog.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ali A. Al-Zahrani
- Department of Urology, College of Medicine; University of Dammam; Alkhobar Saudi Arabia
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Anderson BB, Pariser JJ, Pearce SM, Volsky JG, Bales GT, Chung DE. Safety and Efficacy of Retropubic Mid-urethral Sling Placement in Women Who Void With Valsalva. Urology 2016; 91:52-7. [DOI: 10.1016/j.urology.2016.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
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Safety and efficacy of single-incision sling for female stress urinary incontinence: 3 years’ results. Int Urogynecol J 2016; 27:1667-1671. [DOI: 10.1007/s00192-016-3001-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
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Evaluation and surgery for stress urinary incontinence: A FIGO working group report. Neurourol Urodyn 2016; 36:518-528. [DOI: 10.1002/nau.22960] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/20/2015] [Indexed: 02/04/2023]
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Schauer I, Bock H, Eredics K, Wallis M, Scholz M, Madersbacher S, Lüftenegger W. 10 years follow-up after mid-urethral sling implantation: high rate of cure yet a re-occurrence of OAB-symptoms. Neurourol Urodyn 2016; 36:614-619. [PMID: 26859307 DOI: 10.1002/nau.22972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/14/2016] [Indexed: 11/09/2022]
Abstract
AIMS To assess the long-term outcome of mid-urethral slings regarding urinary incontinence (UI) and lower urinary tract symptoms and to identify risk factors for an unsatisfactory outcome. METHODS Analysis of a prospective institutional database. For the current analysis only women who reached the 10 years follow-up were eligible. Outcome was assessed using a detailed, non-validated questionnaire on continence status and on several aspects of lower urinary tract function. RESULTS A total of 256 women were operated during 1999-2004, in 139 (54.3%), a 10 years follow-up was available and these patients were included. Mean age at surgery was 63 years. At the 2, 5, and 10 years follow-up, the percentages of women reporting 0-1 pads/day were 96.4%, 97.1% and 88.5%, respectively. More than 95% of the patients reported no stress UI at the 2, 5, and 10 years follow-up. At baseline, urgency was reported by 61.2%, this figure dropped to 17.3% at 2 years and increased thereafter to 32.4% (5 years) and 41.7% (10 years). De novo urgency was present in 3.6% after 2 years, in 10.8% after 5 years, and 14.4% after 10 years. The percentage of patients with a high degree of treatment satisfaction declined from 79.1% at 2 years to 70.5% at 5 years, and 62.6% at 10 years. Risk factors for an unsatisfactory long-term outcome were advanced age, the presence of urgency, nocturia, and decreased bladder capacity at baseline. CONCLUSIONS This study confirms the excellent long-term efficacy of mid-urethral slings regarding the management of stress UI. A substantial number of women develop OAB-symptoms after the procedure that largely contribute to outcome dissatisfaction. Neurourol. Urodynam. 36:614-619, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ingrid Schauer
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Helena Bock
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Klaus Eredics
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Martina Wallis
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
| | - Michael Scholz
- Department of Urology, Kaiser-Franz-Josef Hospital, Vienna, Austria
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Prospective randomized comparison of the transobturator mid-urethral sling with the single-incision sling among women with stress urinary incontinence: 1-year follow-up study. Int Urogynecol J 2015; 27:791-6. [DOI: 10.1007/s00192-015-2895-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/15/2015] [Indexed: 11/27/2022]
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Xin X, Song Y, Xia Z. A comparison between adjustable single-incision sling and tension-free vaginal tape-obturator in treating stress urinary incontinence. Arch Gynecol Obstet 2015; 293:457-63. [PMID: 26573010 DOI: 10.1007/s00404-015-3949-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the subjective and objective cure rates, postoperative pain, postoperative complications, and postoperative quality of life of adjustable single-incision sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the treatment of female stress urinary incontinence (SUI). METHODS Female patients with SUI (N = 368) were randomized to receive either Ajust® (N = 184) or TVT-O™ procedure (N = 184) between January 2012 and October 2013. Efficacy was evaluated using cure rate, postoperative complications, postoperative pain profile (using Visual Analogue Scale), Patient Global Impression of Improvement Scale, and International Consultation on Incontinence Questionnaire-Short Form. RESULTS The patients from Ajust® and TVT-O™ groups had no statistically significant difference in subjective and objective cure rates (94.4 vs 90.7 %, P = 0.171; 97.2 vs 90.7 %, P = 0.195). Compared with the TVT-O™ group, patients in the Ajust® group had significantly less postoperative pain, shorter operative duration, and less intraoperative blood loss (all P values < 0.05). No significant difference in perioperative complications was observed between these two groups. Patients in Ajust® group had shorter recovery time (P < 0.001) compared to TVT-O™ group. The postoperative quality of life of patients in these two groups was significantly improved compared to baseline; however, no significant difference was observed in the average improvement of life between these two groups (P = 0.115). CONCLUSIONS Ajust® procedure is simple, safe, and effective for the treatment of SUI. Compared with TVT-O™, patients receiving Ajust® had less intraoperative blood loss, less postoperative pain, and shorter recovery time.
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Affiliation(s)
- Xing Xin
- Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Yue Song
- Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Zhijun Xia
- Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, Olugbade K, Bendavid R, Iakovlev V. Safety considerations for synthetic sling surgery. Nat Rev Urol 2015; 12:481-509. [DOI: 10.1038/nrurol.2015.183] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zhang Z, Zhu L, Xu T, Lang J. Retropubic tension-free vaginal tape and inside-out transobturator tape: a long-term randomized trial. Int Urogynecol J 2015; 27:103-11. [DOI: 10.1007/s00192-015-2798-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 11/30/2022]
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Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis. Int Urogynecol J 2015; 26:1253-68. [DOI: 10.1007/s00192-015-2645-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/27/2015] [Indexed: 11/29/2022]
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Batalden RP, Weinstein MM, Foust-Wright C, Alperin M, Wakamatsu MM, Pulliam SJ. Clinical application of IUGA/ICS classification system for mesh erosion. Neurourol Urodyn 2015; 35:589-94. [PMID: 25874639 DOI: 10.1002/nau.22756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/22/2015] [Indexed: 11/07/2022]
Abstract
AIMS Our aim was to assess the usability of the IUGA/ICS classification system for mesh erosion in a tertiary clinical practice and to determine if assigned classification is associated with patient symptoms, treatment, and outcome. METHODS We retrospectively identified women who had mesh erosion after prolapse or incontinence surgery. Each erosion was classified using the IUGA/ICS category time site (CTS) system. Associations between classification and presenting symptom (asymptomatic, pain, bleeding, voiding, or defecatory dysfunction, infection, prolapse), treatment type, and outcome were evaluated with chi-squared test, student's t-test, and univariate logistic regression. RESULTS We identified 74 subjects with mesh erosion; only 70% were classifiable. Asymptomatic patients (n = 19) (Category A) were more likely to be managed conservatively (P = 0.001). Symptomatic patients (n = 55) (Category B) were more likely to be managed surgically (P = 0.003). Other variables had no association with treatment. No variables were associated with outcome. Presenting symptom was associated with both treatment (P = 0.005) and outcome (P = 0.03). Asymptomatic subjects were more likely to have satisfactory outcome (P = 0.03). Urinary frequency and urgency were highly correlated with surgical management (P = 0.02). CONCLUSIONS One third of mesh erosions could not be retrospectively coded using the IUGA/ICS classification. The components of the system were not predictive of treatment nor outcome with exception of the Category A (asymptomatic) and Category B (symptomatic). Asymptomatic women with mesh erosion can be successfully managed with conservative measures. Use of a classification system may be enhanced if the system is simplified by limiting the number of variables to those associated with interventions and patient outcome. Neurourol. Urodynam. 35:589-594, 2016. © 2015 Wiley Periodicals, Inc.
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Abstract
Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation's female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort.
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YAMANISHI T, KAGA K, FUSE M, SHIBATA C, UCHIYAMA T. Neuromodulation for the Treatment of Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 7:121-32. [DOI: 10.1111/luts.12087] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/11/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Tomonori YAMANISHI
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Kanya KAGA
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Miki FUSE
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Chiharu SHIBATA
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Tomoyuki UCHIYAMA
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
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Abstract
OBJECTIVES The aim of this study was to describe how women experience vaginal mesh complications after optimized tertiary care level treatment. METHODS We conducted telephone interviews in 2012 with women at least 6 months after presentation to our tertiary care clinic between 2006 and 2011 for complications related to vaginal mesh and transcribed verbatim responses to 2 open-ended questions about their experiences surrounding vaginal mesh complications. We analyzed data using qualitative description with low-inference interpretation in a team-based setting followed by consensus meetings to arrive at descriptive trajectories of their experiences. RESULTS Of 111 women, we successfully contacted 88, and 84 agreed to the interview. The mean duration from index mesh surgery to interview was 4.5 years, and the mean duration from presentation to our clinic for complications to the interview was 2.3 years. The effects of mesh complications caused both physical and emotional pain, in addition to the discomfort of the original pelvic floor dysfunction. The women's experiences followed 1 of 3 recovery trajectories. In "cascading health problems," the women experienced a spiral of health problems, anxiety, and desperation. In "settling for a new normal," the women who once considered themselves healthy now believed that they are unhealthy and worked to adjust to their degraded health status. In "returning to health," the women described a return to health. The women still symptomatic discharged from tertiary care clinic expressed hopelessness and abandonment. CONCLUSIONS Concomitant with ongoing research to improve the safety of vaginal mesh procedures, there must be dedicated efforts to develop and study a range of therapies for holistically treating women with mesh complications.
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Abstract
OBJECTIVES The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh. METHODS Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments. RESULTS A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse. CONCLUSIONS Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.
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Hamann MF, Naumann CM, Knüpfer S, Jünemann KP, Bauer R. [Urogynecology II: urinary incontinence in men and women: surgical treatment of urinary incontinence and prolapse]. Urologe A 2014; 53:1671-80; quiz 1681-2. [PMID: 25316184 DOI: 10.1007/s00120-014-3607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Numerous surgical procedures are available for the treatment of stress urinary incontinence in women and men. On a par with classical therapy options (e.g. colposuspension and artificial sphincter prosthesis) suburethral tape procedures have become established as the minimally invasive standard of care. Regarding comorbidities and recurrent urinary incontinence, therapeutic procedures should be modified on an individual basis. It is crucial to involve patients in therapeutic decision-making and counseling should be given with respect to all conservative and operative alternatives.
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Affiliation(s)
- M F Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 7, 24105, Kiel, Deutschland,
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Blaivas JG, Mekel G. Management of Urinary Fistulas Due to Midurethral Sling Surgery. J Urol 2014; 192:1137-42. [DOI: 10.1016/j.juro.2014.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Jerry G. Blaivas
- Weill Cornell Medical College, New York, New York
- Institute for Bladder and Prostate Research, New York, New York
| | - Gabriel Mekel
- Institute for Bladder and Prostate Research, New York, New York
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Vieillefosse S, Thubert T, Deffieux X. [Miduretral sling and sexuality: a systematic review]. Prog Urol 2014; 24:682-90. [PMID: 25214449 DOI: 10.1016/j.purol.2014.06.013] [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: 06/04/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess influence of miduretral sling (MUS) on patient's sexuality. METHODS A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "stress urinary incontinence", "sexual function", "anti-incontinence surgery", "minimaly invasive slings", "mid-urethral slings", "tension-free vaginal tape", "transobturator vaginal tape". Sixty-nine articles really dealt with the impact of MUS on sexuality. RESULTS The data were expressed as the median and interquartile range (IQR; 25th-75th percentile). After MUS surgery, 30% (21-37) patients had sexuality improvement, 8.5% (4.7-14) had sexuality impairment and 60% (53-73) didn't report change on their sexuality. CONCLUSION MUS surgery didn't seem to impair significantly patient's sexuality.
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Affiliation(s)
- S Vieillefosse
- Gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - T Thubert
- Gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - X Deffieux
- Gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
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Hogewoning CRC, Gietelink L, Pelger RCM, Hogewoning CJA, Bekker MD, Elzevier HW. The introduction of mid-urethral slings: an evaluation of literature. Int Urogynecol J 2014; 26:229-34. [PMID: 25143007 DOI: 10.1007/s00192-014-2488-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/06/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate the degree and reliability of evidence used by manufacturers before the introduction of mid-urethral slings (MUS) onto the commercial market. Furthermore, minimum standards for marketed slings are recommended by evaluating recent suggestions for the introduction of gynecological meshes. METHODS A systematic literature search was conducted using PubMed and commercial internet search engines in order to identify slings introduced by the industry over the last decade. Moreover, manufacturers were contacted by email, mail, and phone to provide data from before the introduction of the slings onto the commercial market. Once contact had been initiated, a 6-month deadline was set for data collection. RESULTS Forty-one slings introduced between 1996 and 2012 were identified. Ten slings were described in a total of 20 studies with sample sizes varying from 10 to 368. The 41 MUS were produced by a total of 19 different companies. Seven companies never responded to recurrent emails, phone calls or other means of attempted contact. Thirty-one slings (76%) remained without any comparative pre-launch data. CONCLUSIONS Mid-urethral slings were often introduced without any scientifically proven basis or pre-launch research. The US Food and Drug Administration and the European authorities should undertake immediate action by imposing strict rules before the launch of new MUS comparable with those recently suggested for meshes used in vaginal prolapse surgery.
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Affiliation(s)
- Cornelis R C Hogewoning
- Department of Urology, Leiden University Medical Center, Postzone J3-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
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Taner CE, Okay G, Göklü Y, Başoğul Ö, Başoğul N. Perioperative and postoperative complications after Ophira mini sling operations. Arch Gynecol Obstet 2014; 291:341-6. [PMID: 25138122 DOI: 10.1007/s00404-014-3402-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Cüneyt Eftal Taner
- Ministry of Health Tepecik Education and Research Hospital, Izmir, Turkey
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Sirls LT, Rosenblum N. Transobturator versus retropubic approach for a mid urethral sling. J Urol 2014; 192:1326-8. [PMID: 25130525 DOI: 10.1016/j.juro.2014.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Larry T Sirls
- Department of Urology, Female Pelvic Medicine & Reconstructive Surgery, William Beaumont Hospital, Royal Oak, Michigan
| | - Nirit Rosenblum
- Department of Urology, Female Pelvic Medicine & Reconstructive Surgery, NYU Langone Medical Center, New York, New York
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Outcomes of trocar-guided Gynemesh PS™ versus single-incision trocarless Polyform™ transvaginal mesh procedures. Int Urogynecol J 2014; 26:71-7. [DOI: 10.1007/s00192-014-2467-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
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Naidu M, Thakar R, Sultan AH. Outcomes of minimally invasive suburethral slings with and without concomitant pelvic organ prolapse surgery. Int J Gynaecol Obstet 2014; 127:69-72. [DOI: 10.1016/j.ijgo.2014.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/24/2014] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
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Randomized controlled trial comparing TVT-O and TVT-S for the treatment of stress urinary incontinence: 2-year results. Int Urogynecol J 2014; 25:1343-8. [DOI: 10.1007/s00192-014-2352-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
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Abstract
Pelvic organ prolapse is highly prevalent, and negatively affects a woman’s quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider. These may include the location(s) of anatomic defects, the severity of prolapse symptoms, the activity level of the woman, and concerns regarding the durability of the repair. In many instances, women and their surgeons are challenged to weigh the risks and benefits of native tissue versus mesh-augmented repairs. Though mesh-augmented repairs may offer better durability, they are also associated with unique complications, such as mesh erosion. Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques. Biologic grafts may also be considered to improve durability of a surgical repair, while avoiding potential complications of synthetic mesh. In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse. Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.
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Affiliation(s)
- Nazema Y Siddiqui
- Division of Urogynecology and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Autumn L Edenfield
- Division of Urogynecology and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
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