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Barba M, Cola A, Costa C, Liberatore A, Frigerio M. Efficacy and Adverse Effects After Single-Incision Slings for Women with Stress Urinary Incontinence: A 12-Year Follow-Up. Int J Womens Health 2023; 15:1077-1082. [PMID: 37483887 PMCID: PMC10362859 DOI: 10.2147/ijwh.s410539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Single-incision slings (SISs) are not considered the first surgical choice for stress urinary incontinence due to few data about long-term results. Our aim was to evaluate the outcomes of SISs 12 years after implantation and to search for consequences such as deterioration after a certain amount of time. Methods We included women with stress urinary incontinence both clinically and urodynamically proven who underwent SISs procedure. Objective and subjective cure rates were compared to short-term outcomes to detect possible deterioration over time. Results A total of 85 patients were analysed with a median follow-up of 12.0 (IQR 10.4-12.8) years. Objective and subjective cure rates were 81.0% and 82.1%, respectively. Median (IQR) PGI-I scores and ICIQ-SF, respectively, were 1 (1-2) and 0 (0-6.8). No significant deterioration of outcomes over time was shown after comparison between short-term and long-term follow-ups (objective cure rate 84.5% vs 81.0%, p=0.684; subjective cure rates 92.9% vs 82.1%, p=0.060). Also, voiding symptoms and overactive bladder did not differ over time (20.2% vs 21.4%, p=1.000; 20.2% vs 33.3%, p=0.080, respectively). Conclusion SISs were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up.
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Affiliation(s)
- Marta Barba
- Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Clarissa Costa
- Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy
| | | | - Matteo Frigerio
- Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Comparison of early loosening vs delayed section of mid-urethral slings for postoperative voiding dysfunction. Int Urogynecol J 2023; 34:675-681. [PMID: 35445807 DOI: 10.1007/s00192-022-05095-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder outlet obstruction (BOO) is a common occurrence after midurethral sling (MUS) insertion and can result in acute or chronic urinary retention or de novo lower urinary tract symptoms (LUTS). However, the management of BOO after MUS is not standardised. The objective of this study was to compare two therapeutic strategies for suspected BOO after MUS. METHODS Patients who had surgical revision for voiding dysfunction with a post-void residual (PVR) ≥100 ml after MUS in five centres between 2005 and 2020 were included in a retrospective study. Patients were divided into two groups: early sling loosening (EL) vs delayed section/excision of the sling (DS). RESULTS Seventy patients were included: 38 in the EL group and 32 in the DS group. The postoperative complication rate was comparable in both groups (10.5% vs 12.5%; p = 0.99). At 3 months, the rate of withdrawal from self-catheterisation was similar in the two groups (92.1% vs 100%; p = 0.25) as was the PVR (57.5 vs 63.5 ml; p = 0.09). After a median follow-up of 9 months, there were significantly more patients with resolved voiding dysfunction in the EL group (63.2% vs 31.3%; p = 0.01). The rate of persistent/recurrent stress urinary incontinence (SUI) was higher in the DS group (21% vs 43.7%; p = 0.04). In multivariate analysis, the main predictive factor of recurrent SUI was DS (OR 2.87, 95% CI 1.01-8.60, p = 0.048). CONCLUSIONS Early loosening of MUS in the case of postoperative voiding dysfunction offers better efficacy than DS of the sling, with a lower risk of recurrent/persistent SUI.
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Haudebert C, Richard C, Common H, Hascoet J, Bentellis I, Freton L, Voiry C, Samson E, Manunta A, Brucker B, Peyronnet B. Bandelette aponévrotique pubovaginale pour incontinence urinaire d’effort chez les femmes à risque de complications prothétiques. Prog Urol 2022; 32:500-508. [DOI: 10.1016/j.purol.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
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Pandey D, Jatana V, Inukollu PR, Fuenfgeld C. Post-operative tension adjustment-A simple technical modification in mid-urethral slings (MUS) for stress urinary incontinence (SUI). Eur J Obstet Gynecol Reprod Biol 2021; 260:78-84. [PMID: 33744504 DOI: 10.1016/j.ejogrb.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mid-urethral sling (MUS) surgeries have revolutionized the management of stress urinary incontinence (SUI). However, MUS is a delicate balance of tension on the mid urethral segment with a 12 % risk of failure to achieve complete continence; and up-to 20 % chance of post-operative voiding dysfunction. We propose a simple technical modification in which the long ends of the tape at suprapubic or groin area are not cut immediately and are covered with a sterile dressing. After 48-72 h post-surgery the patient is checked for continence and voiding difficulties. Following this an ultrasonographic assessment of post-void residual urine is performed. Keeping in mind these 3 criteria the tape is adjusted. After complete subjective as well as objective satisfaction the long ends of tape are cut. MATERIAL AND METHODS This is a retrospective analysis of women who underwent MUS surgery for the management of SUI, with our simple technical modification of tape adjustment in the postoperative period. A total of 17 patients operated by single surgeon in one year were included. RESULTS Our results show that 58.8 % of our patients who underwent MUS procedures required post-operative tape adjustment. The number was significantly higher in the MUS - Retropubic group (85.7 %) as compared to the MUS - Obturator group (40 %). Three patients in the MUS - Retropubic group required a second time tape adjustment. Following tape adjustment all patients had complete continence (subjective and objective), with no voiding dysfunction. CONCLUSION The incidence of postoperative voiding dysfunction is significant following MUS surgery for SUI. A simple technical modification of delaying the cutting of the tape for two to three days gives the opportunity for perfect tension adjustment.
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Peyronnet B, Greenwell T, Gray G, Khavari R, Thiruchelvam N, Capon G, Ockrim J, Lopez-Fando L, Gilleran J, Fournier G, Van Koeveringe GA, Van Der Aa F. Current Use of the Artificial Urinary Sphincter in Adult Females. Curr Urol Rep 2020; 21:53. [PMID: 33098485 DOI: 10.1007/s11934-020-01001-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. RECENT FINDINGS While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50 years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France. .,Service d'Urologie, Hopital Pontchaillou, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Gary Gray
- Department of Urology, University of Alberta, Edmonton, Canada
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| | - Luis Lopez-Fando
- Department of Urology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA
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Frigerio M, Milani R, Barba M, Locatelli L, Marino G, Donatiello G, Spelzini F, Manodoro S. Single-incision slings for the treatment of stress urinary incontinence: efficacy and adverse effects at 10-year follow-up. Int Urogynecol J 2020; 32:187-191. [PMID: 32902762 DOI: 10.1007/s00192-020-04499-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Single-incision slings are not considered a first-choice surgical treatment owing to a lack of data about long-term outcomes. We aimed to assess the long-term results of urinary incontinence treatment after single-incision sling implantation at 10 years' follow-up and to investigate possible deterioration over time. METHODS This retrospective study analyzed women with subjective and urodynamically proven stress urinary incontinence who underwent single-incision sling procedure. The objective cure rate was assessed with a 300-ml stress test. The subjective cure rate was determined by the Patient Global Impression of Improvement (PGI-I) questionnaire. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire scores and self-answered patient-satisfaction scales were collected to assess symptom severity. Findings were compared with short-term outcomes in the same patients, available through our previous database, in order to detect possible outcome deterioration over time. RESULTS The records of 60 patients were analyzed. Nine patients (15%) were lost to follow-up. A total of 51 patients completed the evaluation, with a mean follow-up of 10.3 ± 0.7 years. Objective and subjective cure resulted 86.3% and 88.2% respectively. Mean PGI-I scores and ICIQ-SF were 1.5 ± 1.0 and 3.2 ± 4.8 respectively. Patients' satisfaction scored 8.6 ± 2.6 out of 10. No long-term complications occurred. Comparison of short-term (2.6 ± 1.4 years after surgery) and long-term follow-up did not show a significant deterioration of outcome over time. CONCLUSIONS Single-incision slings were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up. Cure rates and functional outcomes did not show any deterioration over time compared with short-term results.
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Affiliation(s)
| | | | | | | | | | | | | | - Stefano Manodoro
- ASST Santi Paolo e Carlo, Ospedale San Paolo, via Antonio di Rudini, Milan, Italy.
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Kuprasertkul A, Zimmern P. Challenges of Very Long-term Reporting in Stress Urinary Incontinence Surgeries in Women. Urology 2020; 139:50-59. [DOI: 10.1016/j.urology.2020.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/04/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Which procedure for stress urinary incontinence? Synthetic slings. Curr Opin Urol 2020; 30:275-276. [DOI: 10.1097/mou.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giarenis I, Malde S, Harding C, Robinson D, Gajewski J, Rahnamai M, Cardozo L. Do we need better information to advise women with stress incontinence on their choice of surgery? Report from the ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S98-S103. [PMID: 31821636 DOI: 10.1002/nau.24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/02/2019] [Accepted: 03/04/2019] [Indexed: 11/06/2022]
Abstract
AIMS The regulatory warnings about the safety of the synthetic midurethral slings (MUS) had a significant effect on how patients and physicians approach surgical management of stress urinary incontinence (SUI). In this changing landscape, the purpose of this research Think Tank (TT) was to provide an update of the current knowledge about the safety and efficacy of SUI surgery, to review patient goals and expectations and to identify factors affecting the decision making for surgery. METHODS This is a consensus report of the proceedings of TT3: "Do we need better information to advise women with stress incontinence on their choice of surgery?" from the annual International Consultation on Incontinence-Research Society (ICI-RS), June 2018. RESULTS Despite the body of evidence supporting the continued use of MUS, the short follow-up of most of the studies and the lack of "real life" data regarding pain and sexual dysfunction make the development of recommendations challenging. Women with SUI are often happy to "trade" efficacy for a procedure with less associated morbidity and therefore it is not always the procedure with the highest success rate that is ultimately chosen. However, a number of factors influence treatment decision and there is limited evidence about what level of all these factors women are willing to tolerate for a given success rate, or how much success they are willing to trade for a lower complication rate. CONCLUSIONS The ICI-RS proposed research questions which may be able to assist in improving the counseling and management of women with SUI.
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Affiliation(s)
- Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Jerzy Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohammad Rahnamai
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany.,Department of Urology, Maastricht University, Maastricht, The Netherlands
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Palmerola R, Peyronnet B, Rebolos M, Khan A, Sussman RD, Escobar C, Smith S, Rosenblum N, Nitti VW. Trends in Stress Urinary Incontinence Surgery at a Tertiary Center: Midurethral Sling Use Following the AUGS/SUFU Position Statement. Urology 2019; 131:71-76. [PMID: 31229514 DOI: 10.1016/j.urology.2019.04.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate trends in stress urinary incontinence (SUI) surgery before and after the 2011 Foods and Drug Administration notification and the 2014 (American Urogynecologic Society [AUGS]/Society for Urodynamics Female Pelvic Medicine and Urogenital Reconstruction [SUFU]) position statement. METHODS A retrospective chart review was performed to identify patients presenting for evaluation of SUI by 2 Female Pelvic Medicine and Reconstructive Surgery specialists between June 1, 2010 and May 31, 2017. Rates of surgical treatment modality (synthetic midurethral slings [MUS] versus autologous fascial pubovaginal sling versus bulking agents) were analyzed at 6-month intervals. RESULTS Over fourteen 6-month intervals, the number of new patients presenting for evaluation of SUI increased consistently. There was a decrease in the proportion of new patients who underwent antiincontinence surgical procedures, specifically MUS, between December 2011 and December 2013. After the integration of the 2014 AUGS/SUFU position statement in patient counseling, this trend reverted and we noted a sustained increase in the proportion of patients electing surgical management. This paralleled an increase in new patient visits for SUI and MUS. The number autologous fascial pubovaginal sling remained stable throughout the study period. Conversely, MUS composed the highest proportion of procedures performed, accounting for 60 %-87.2% off all antiincontinence procedures. CONCLUSION After the Foods and Drug Administration Public Health Notification in 2011, we observed a decline in the number of new patients presenting with SUI electing surgical management, specifically MUS. However, after the AUGS/SUFU position statement publication and integration into counseling, we observed a reversal in the previous year's trends, noting a resurgence of MUS utilization.
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Affiliation(s)
- Ricardo Palmerola
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY.
| | - Benoit Peyronnet
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Mark Rebolos
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Aqsa Khan
- Department of Urology, Mayo Clinic, Phoenix, AZ
| | - Rachael D Sussman
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Christina Escobar
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | | | - Nirit Rosenblum
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Victor W Nitti
- Departments of Urology and Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Haylen BT, Lee JKS, Sivagnanam V, Maher CF. Total tape ban: Not the answer! Neurourol Urodyn 2018; 37:2035-2037. [DOI: 10.1002/nau.23794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 11/08/2022]
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