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Chao WT, Chen GY, Liu CH, Chang CP, Wang PH, Horng HC. Efficacy of the new adjustable I-stop-mini sling system in women with stress urinary incontinence and intrinsic sphincter deficiency: A retrospective cohort study. Int J Gynaecol Obstet 2023; 160:263-270. [PMID: 35780463 DOI: 10.1002/ijgo.14327] [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: 03/16/2022] [Revised: 06/18/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We aimed to evaluate the efficacy, surgical outcomes, and adverse events of the adjustable midurethral sling I-stop-mini in women with intrinsic sphincter deficiency (ISD)-type stress urinary incontinence. We compared this new sling system with the Obtryx transobturator midurethral sling system. METHODS This retrospective cohort study was conducted at a single center from June 2017 to December 2020. A total of 141 women who underwent placement of an I-stop-mini or Obtryx and were followed up for at least 1 year were enrolled. ISD was defined as a Valsalva leak point pressure of ≤60 cmH2 O or a maximal urethral closure pressure of ≤20 cmH2 O. Student t test was used to compare continuous variables, and chi-square test was used to compare the distribution of categorical data. RESULTS In terms of objective success, I-stop-mini and Obtryx showed no significant differences in the postoperative 1-month, 6-month, and 12-month. The two devices showed similar effectiveness regardless of the ISD definition. The I-stop-mini group had a significantly shorter operative time, whereas the adverse event rates were similar. CONCLUSION The subjective cure rate, objective success, and adverse event rate did not differ in the two devices. I-stop-mini had a significantly shorter operative time.
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Affiliation(s)
- Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC
| | - Guan-Yeu Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Pei Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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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] [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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Chiang FC, Sun R, Chang YJ, Li YI, Sun MJ. Comparison of Clinical Efficacy and Urodynamic Changes Using Single-incision Slings (MiniArc ® vs. Solyx™) for the Treatment of Female Stress Urinary Incontinence. Gynecol Minim Invasive Ther 2021; 10:235-242. [PMID: 34909381 PMCID: PMC8613486 DOI: 10.4103/gmit.gmit_102_20] [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: 08/05/2020] [Revised: 03/15/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To compare the clinical efficacy and urodynamic parameter changes between the MiniArc and the Solyx sling for the treatment of female urodynamic stress incontinence (USI). Materials and Methods: One-hundred and thirty (MiniArc n = 79, BS-Solyx n = 51) patients were included in this study. Cough stress test (ST), pad test (PT), Incontinence Impact short form Questionnaire (IIQ-7), Urogenital Distress Inventory six-item questionnaire (UDI-6), Sexual Questionnaire-Short Form (PIS-Q), and urodynamic parametric changes were assessed to determine objective and subjective outcomes following the procedure. Objective cure was defined as negative ST and PT <2 g and subjective cure was defined as “No” to the answer of UDI-6 Question #3. Predictors of surgical failure were also determined. Results: All Solyx users, as opposed to 91.1% of MiniArc patients, obtained objective cure at postoperative 3 months (P = 0.042). No significant difference in subjective cure rates (93.7% vs. 90.2% at 3-months (P = 0.513); 89.9% vs. 80.4% at 1 year for Solyx and MiniArc patients, respectively (P = 0.126)) and improvement scores in UDI-6 and IIQ-7 were observed. The Solyx group incurred more de novo urgency (17.6% vs. 6.3% at 3 months (P = 0.042); 23.5% vs. 7.6% at 1 year (P = 0.01)). Both procedures yielded significant decrements in maximal urethral closure pressure (P < 0.001) and average flow rate (P = 0.015). The preoperative PT and sling type were strong predictors of surgical failure, where the Solyx tape reported lower odds (odds ratio = 0.174, P = 0.02) compared to the MiniArc sling. Conclusion: Single-incision mini-slings are safe and effective treatment for female USI. The Solyx SIS demonstrated superiority over the MiniArc in this study based on its higher objective cure rate and lower risk for surgical failure.
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Affiliation(s)
- Fook Chin Chiang
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Changhua Christian Hospital, Changhua, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Cheng Ching Hospital, Taichung, Taiwan
| | - Ryan Sun
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, Canada
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Ing Li
- Center for Urinary Incontinence and Voiding Dysfunction, Changhua Christian Hospital, Changhua, Taiwan
| | - Mou-Jong Sun
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Changhua Christian Hospital, Changhua, Taichung, Taiwan.,Center for Urinary Incontinence and Voiding Dysfunction, Changhua Christian Hospital, Changhua, Taiwan
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Chao WT, Huang HY, Chen GY, Liu CH, Chan IS, Chang CP, Chen YJ, Wang PH, Horng HC. Efficacy and Safety of "I-stop-mini adjustable" Sling System Versus Transobturator Midurethral "Obtryx" Sling System in Stress Urinary Incontinence: A Retrospective Cohort Study. J Minim Invasive Gynecol 2021; 29:519-527. [PMID: 34902596 DOI: 10.1016/j.jmig.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To compare the safety, efficacy, and adverse events of the new mini-adjustable sling system "I-stop-mini" with transobturator midurethral slings "Obtryx" in women with stress urinary incontinence (SUI). DESIGN A single-center, retrospective cohort study. SETTING Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, Patients: Three hundred and forty-seven patients who underwent I-stop-mini or Obtryx for SUI treatment. INTERVENTION Mid-urethral sling with either I-stop-mini or Obtryx. MEASUREMENTS AND MAIN RESULTS The primary outcomes were objective success and subjective cure rates between the two groups. Objective success was evaluated using a one-hour pad test and subjective cure was evaluated using a questionnaire score (IIQ-7, UDI-6, ICIQ-SF). Secondary outcomes were the evaluation of surgical outcomes, operative data, and adverse events between the two groups. In total, 171 of 200 I-stop-mini subjects and 127 of 147 Obtryx subjects completed 12 months of follow-up. Regarding the objective success between the I-stop-mini group and the Obtryx group, 1 month postoperative (3.6±5.2 vs. 3.9±12.6; p = .765), post-operative 6 month (3.9±5.1 vs. 4.2±12.6; p = .848), 12 month (4.6±5.6 vs. 4.5±13.6; p = .980) one-hour pad tests showed no significant difference. The 12-month subjective cure rates decreased from 94.7% (1 month post-operative) to 91.2% (12 months post-operative) in the I-stop-mini group and 95.2% (1 month post-operative) to 85.0% (12 months post-operative) in the Obtryx group. Similar and durable efficacy was observed between the two groups. The I-stop-mini group had shorter operative times and hospital stays than the Obtryx group; however, both groups showed similar adverse event rates. CONCLUSION The objective success and subjective cure rates of I-stop-mini did not differ to those of Obtryx. However, long-term data and further prospective studies on I-stop-mini are necessary to arrive at a definite conclusion.
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Affiliation(s)
- Wei-Ting Chao
- Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Yi Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC
| | - Guan-Yeu Chen
- Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Hao Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-San Chan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Pei Chang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Huann-Cheng Horng
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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Demir O, Kaya FM, Sal H, Ozalp M, Comba C, Aran T. Vulvar abscess as a late complication following the minimally-invasive Mini-Sling procedure for stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2020; 256:514-515. [PMID: 33168268 DOI: 10.1016/j.ejogrb.2020.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Omer Demir
- Karadeniz Technical University Faculty of Medicine, Department of Obstetrics and Gynecology, Trabzon, Turkey.
| | - Fatih Mehmet Kaya
- Karadeniz Technical University Faculty of Medicine, Department of Obstetrics and Gynecology, Trabzon, Turkey
| | - Hidayet Sal
- Ordu Fatsa State Hospital, Department of Obstetrics and Gynecology, Trabzon, Turkey
| | - Mirac Ozalp
- Karadeniz Technical University Faculty of Medicine, Department of Obstetrics and Gynecology, Trabzon, Turkey
| | - Cihan Comba
- Sultangazi Haseki Training and Research Hospital, University of Health Sciences, Department of Gynecologic Oncology, Istanbul, Turkey
| | - Turhan Aran
- Karadeniz Technical University Faculty of Medicine, Department of Obstetrics and Gynecology, Trabzon, Turkey
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White AB, Kahn BS, Gonzalez RR, Rosamilia A, Anger JT, Eilber KS, Schaffer JI. Prospective study of a single-incision sling versus a transobturator sling in women with stress urinary incontinence: 3-year results. Am J Obstet Gynecol 2020; 223:545.e1-545.e11. [PMID: 32184149 DOI: 10.1016/j.ajog.2020.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Long-term safety and efficacy data on use of single-incision slings in stress urinary incontinence are limited. OBJECTIVE To determine whether the single-incision sling Solyx (Boston Scientific, Marlborough, MA) is noninferior to the transobturator sling Obtryx II (Boston Scientific) in efficacy and safety for treatment of stress urinary incontinence. This 522 post-market surveillance study has been designed in response to a Food and Drug Administration request to evaluate improvement in stress urinary incontinence at 36 months following single-incision sling compared with baseline, as well as provide an assessment of mesh-related complications and subject-reported outcomes, relative to the transobturator sling control. STUDY DESIGN This prospective, nonrandomized, parallel cohort, multicenter postapproval study enrolled subjects to receive single-incision sling or transobturator sling. Study sites were assigned to a cohort group based on documented competency with the cohort device. Patient follow-up was 36 months to compare efficacy and adverse events for noninferiority. Inclusion criteria included stress predominant urinary incontinence, a positive cough stress test, and post-void residual ≤150 cc. Participants were ineligible if they had undergone previous stress urinary incontinence surgery or had a previous mesh complication. Primary endpoint was treatment success defined by composite negative cough stress test and subjective improvement in stress urinary incontinence using Patient Global Impression of Improvement at 36 months. Secondary endpoints included adverse events and indications for retreatment. Noninferiority margins of 15% and 10% were prespecified for the primary efficacy and safety endpoints. Data analysis was performed using intent-to-treat and per-protocol methods. Due to the observational nature of the study, a propensity score methodology was applied to account for differences in patient and surgeon characteristics between treatment groups. The study design and variables to be included in the propensity score model were reviewed and approved by Food and Drug Administration reviewers before outcome analyses were performed. RESULTS No evidence of imbalance in baseline characteristics was observed between groups after propensity score stratification in the 281 subjects. EBL (72.3±92 vs 73.1±63.9 mL, P=.786), time to spontaneous void (1.1±2 vs 0.8±2.8 days, P=.998), and time to discharge (0.7±0.7 vs 0.6±0.6 days, P=.524) were similar between groups. At 36 months, treatment success was 90.4% in the single-incision sling group and 88.9% in the transobturator sling group (P=.93). At 36 months, mesh-related complications were similar between groups (mesh exposure: 2.8% vs 5.0%, P=.38). Serious adverse events including pain during intercourse (0.7% vs 0%, P=1.00), pelvic pain (0.7% vs 0%, P=1.00), and urinary retention (2.8% vs 4.3%, P=.54) were similar between groups. CONCLUSION Single-incision sling was not inferior to transobturator sling for long-term treatment success of stress urinary incontinence. The rates of serious adverse events were acceptably low and similar between groups.
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Affiliation(s)
- Amanda B White
- Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, TX.
| | - Bruce S Kahn
- Department of Obstetrics and Gynecology, Scripps Clinic, San Diego, CA
| | | | - Anna Rosamilia
- Department of Women's Health, Monash Medical Centre and Cabrini Hospital Melbourne, Australia
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Health System, Los Angeles, CA
| | - Karyn S Eilber
- Department of Surgery, Division of Urology, Cedars-Sinai Health System, Los Angeles, CA
| | - Joseph I Schaffer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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7
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Campos-Delgado M, Quetglas-Muñoz C, Barahona-Orpinell M, García-Tejedor A, Ponce-Sebastià J. Ambulatory MiniArc Precise Sling under Local Anesthesia for Stress Urinary Incontinence: Feasibility and Outcome. Gynecol Minim Invasive Ther 2019; 8:113-117. [PMID: 31544021 PMCID: PMC6743235 DOI: 10.4103/gmit.gmit_104_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 11/04/2022] Open
Abstract
Aims: The aim of the study is to assess the feasibility of ambulatory stress urinary incontinence (SUI) surgery using the MiniArc Precise single-incision urethral sling without increasing the number of complications. Settings and Design: This was a retrospective observational study of prospectively collected data carried out in a Tertiary Referral Hospital in Barcelona, Spain. Materials and Methods: Forty patients diagnosed with SUI or stress predominant mixed urinary incontinence (MUI) treated surgically between November 2011 and November 2013. The MiniArc Precise® sling was inserted under local anesthesia in the ambulatory setting. Statistical Analysis Used: Descriptive statistics included frequencies and percentages for categorical variables and mean and range for quantitative variables. The statistical package used was SPSS version 17.0. Results: Urodynamic studies showed SUI in 78% of cases and stress predominant MUI in 17%. Clinical findings included SUI in 56% of cases and MUI in 44%, with positive stress tests in all participants. The mean intraoperative pain (1–10 Visual Analog Scale) was 2. All patients were satisfied with the use of local anesthesia in the outpatient setting. Perioperative complications did not occur. One case of urinary retention and two cases of urinary tract infection (UTI) developed within this 1st month after operation and were successfully managed conservatively. Midterm complications included eight cases of UTI and four de novo urge incontinence. Conclusions: Placement of the MiniArc Precise sling under local anesthesia is a feasible and safe technique, which when carried out by an experienced surgeon allows to be done as an outpatient basis without increasing the rate of postprocedural complications.
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Affiliation(s)
- Miriam Campos-Delgado
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Cecilia Quetglas-Muñoz
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Marc Barahona-Orpinell
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Amparo García-Tejedor
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Jordi Ponce-Sebastià
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
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Pascom AL, Djehdian LM, Bortolini MA, Jarmy-Di Bella ZI, Delroy CA, Tamanini JT, Castro RA. Randomized controlled trial comparing single-incision mini-sling and transobturator midurethral sling for the treatment of stress urinary incontinence: 3-year follow-up results. Neurourol Urodyn 2018; 37:2184-2190. [DOI: 10.1002/nau.23546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/05/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Ana L.G. Pascom
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
| | | | | | | | - Carlos A. Delroy
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
| | - Jose T.N. Tamanini
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
| | - Rodrigo A. Castro
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
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Jiao B, Lai S, Xu X, Zhang M, Diao T, Zhang G. A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence. Medicine (Baltimore) 2018; 97:e0283. [PMID: 29620645 PMCID: PMC5902257 DOI: 10.1097/md.0000000000010283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To assess the current evidence of effectiveness and safety of single-incision mini-slings (MiniArc) versus transobturator midurethral slings in the management of female stress urinary incontinence (SUI). METHODS A systematic search was performed from the electronic databases including PubMed, EMBASE, and Cochrane Library by November 2017. Using RevMan5.3 statistical software, the primary outcomes including subject and objective cure rates at 6 to 24 months follow-up were evaluated. Meanwhile, analysis was also performed for comparing the secondary outcomes such as peri- and postoperative complications, operative data, and quality of life. RESULTS Six randomized controlled trials (RCTs) and 6 retrospective cohort studies involving 1794 patients with SUI were analyzed based on the inclusion criteria. On the basis of our analysis, MiniArc was proven to have a noninferior clinical efficacy compared with transobturator midurethral slings with respect to the objective cure rate (risk ratio [RR] = 0.98, 95% confidence interval [CI] 0.94-1.03, P = .43) and subjective cure rate (RR = 0.97, 95% CI 0.91-1. 04, P = .38). In addition, pooled analysis showed that MiniArc had significantly lower postoperative pain scores (mean difference [MD] = -1.70, 95% CI -3.17 to -0.23, P = .02) and less postoperative groin pain (RR = 0.42, 95% CI 0.18-0.98, P = .04). Moreover, the MiniArc group also had a significantly shorter operation time (MD = -6.12, 95% CI -8.61 to -3.64, P < .001), less blood loss (MD = -16.67, 95% CI -26.29 to -7.05, P < .001), shorter in-patient stay (MD = 1.30, 95% CI -1.74 to -0.86, P < .001), and less urinary retention risk (RR = 1.15, 95% CI 0.46-2.87, P = .77). However, overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MiniArc compared with transobturator slings. CONCLUSIONS This meta-analysis indicates that MiniArc is an effective method treating SUI. When compared with transobturator slings, it not only has a similar high cure rates, but also is associated with shorter operation time, less blood loss, more favorable recovery time, lower postoperative pain scores, less postoperative groin pain, less urinary retention, and absence of a visible wound. However, the findings of this study should be further confirmed by well-designed prospective RCTs with a larger patient series.
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Affiliation(s)
- Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
| | - Shicong Lai
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
| | - Xin Xu
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Meng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
| | - Tongxiang Diao
- Peking University Fifth School of Clinical Medicine
- Department of Urology, Beijing Hospital, Dongcheng, Beijing, China
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang
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Choi DK, Jung HB, Lee YG, Kim KK, Cho ST. A sequential comparison of postoperative voiding function between two different transobturator sling procedures. Can Urol Assoc J 2017; 10:E372-E376. [PMID: 28096921 DOI: 10.5489/cuaj.3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluated sequential postoperative voiding function of two types of sling procedures (Monarc® and ALIGN®) in patients with stress urinary incontinence. METHODS Ninety-one women diagnosed with urodynamic stress incontinence were randomly assigned to the study. All enrolled patients underwent Monarc or ALIGN procedure. They were postoperatively evaluated at one day, one week, one month, three months, 12 months, and 24 months. The voiding function was evaluated with uroflowmetry and post-void residual urine. Patients were asked if voiding had changed after surgery and had to complete the incontinence quality of life scale (I-QoL) questionnaire at 12 months. RESULTS The Monarc (n=47) and ALIGN (n=44) groups had similar demographic characteristics. The maximal flow rate (Qmax) was significantly decreased on the first day after surgery and gradually increased during the following weeks. Comparing the two groups at one week, the ALIGN group had a significantly decreased Qmax than the Monarc group (17.6 ± 5.2 vs. 20.7 ± 5.0; p=0.004). However, at one, three, 12, and 24 months, there were no significant differences between the two groups. CONCLUSIONS This study demonstrated that an absorbable tensioning suture in the Monarc mesh could increase Qmax compared to ALIGN at one week after surgery. An absorbable tensioning suture may reduce the risk of an early postoperative voiding dysfunction compared to other meshes that do not have this.
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Affiliation(s)
- Don Kyoung Choi
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Ha Bum Jung
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Ki Kyung Kim
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
| | - Sung Tae Cho
- Department of Urology, College of Medicine, Hallym University, Seoul, Korea
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Levi A, Nasra R, Shachar IB, Braun NM. Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia. Int Braz J Urol 2016; 42:1195-1201. [PMID: 27813384 PMCID: PMC5117977 DOI: 10.1590/s1677-5538.ibju.2015.0655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS) procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI). MATERIALS AND METHODS This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A) without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI) cure rate in patients with mixed urinary incontinence (MUI), intra and post-operative complications and patient satisfaction. RESULTS Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective) were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10) and from the local anesthesia. Visual analog scale (VAS) rating was low during and after the procedure (2.38 and 2.69 respectively). CONCLUSIONS The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.
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Affiliation(s)
- Almog Levi
- Department of Obstetrics and Gynecology, Ziv Medical Center, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rasha Nasra
- Department of Obstetrics and Gynecology, Ziv Medical Center, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Inbar Ben Shachar
- Department of Obstetrics and Gynecology, Ziv Medical Center, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Naama Marcus Braun
- Department of Obstetrics and Gynecology, Ziv Medical Center, Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Tieu AL, Hegde A, Castillo PA, Davila GW, Aguilar VC. Transobturator versus single incision slings: 1-year results of a randomized controlled trial. Int Urogynecol J 2016; 28:461-467. [DOI: 10.1007/s00192-016-3128-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/18/2016] [Indexed: 10/20/2022]
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13
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Schellart RP, Casteleijn FM, Dijkgraaf MGW, Tutolo M, Roovers JPWR. Are patients willing to trade cure rate against less pain? Patients' preferences for single incision midurethral sling or transobturator standard midurethral sling. Neurourol Urodyn 2016; 36:1187-1193. [PMID: 27564322 DOI: 10.1002/nau.23093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/29/2016] [Indexed: 12/31/2022]
Abstract
AIMS To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single-incision mini-sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS). METHODS A multi-center, interview-based trade-off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade-off was assessed for two hypothetical durations of substantial postoperative pain after SMUS-2 days or 2 weeks-while simultaneously assuming the absence of substantial postoperative pain after SIMS. RESULTS To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women (P = 0.04) and single women (P = 0.04) were associated with the trade-off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade-off limits were found for patients' actual severity, duration, and frequency of SUI. CONCLUSIONS Patients are willing to accept a slightly lower probability of cure to prevent substantial post-operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surgery.
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Affiliation(s)
- René P Schellart
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Fenne M Casteleijn
- Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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14
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Tension-releasing suture appendage on single-incision sling device: A novel approach to postoperative voiding dysfunctions. Taiwan J Obstet Gynecol 2016; 55:519-24. [DOI: 10.1016/j.tjog.2015.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/21/2022] Open
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15
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Comparison of the clinical outcomes of transobturator and single-incision slings for stress urinary incontinence. Kaohsiung J Med Sci 2016; 32:367-72. [DOI: 10.1016/j.kjms.2016.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/12/2016] [Accepted: 05/26/2016] [Indexed: 11/20/2022] Open
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16
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Tutolo M, De Ridder DJ, Montorsi F, Castagna G, Deprest J, Schellart RP, Ammirati E, Van Der Aa F. A minimum of 1-year follow-up for MiniArc single incision slings compared to Monarc transobturator slings: An analysis to evaluate durability of continence and medium-term outcomes. Neurourol Urodyn 2016; 36:803-807. [DOI: 10.1002/nau.23036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/25/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Manuela Tutolo
- Department of Urology; University Hospitals Leuven; Leuven Belgium
- Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele; Milan Italy
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele; Milan Italy
| | - Giulia Castagna
- Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele; Milan Italy
| | - Jan Deprest
- Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
| | - Renè P. Schellart
- Department of Obstetrics and Gynecology; Spaarne Gasthuis; Harlem The Netherlands
| | - Enrico Ammirati
- Division of Urology Torino; Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino; Piemonte Italy
| | - Frank Van Der Aa
- Department of Urology; University Hospitals Leuven; Leuven Belgium
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Is single incision midurethral sling effective in patients with low maximal urethral closure pressure? Taiwan J Obstet Gynecol 2016; 55:20-5. [DOI: 10.1016/j.tjog.2014.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/17/2022] Open
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18
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Schellart RP, Rengerink KO, Van der Aa F, Lucot JP, Kimpe B, Dijkgraaf MGW, Roovers JPWR. A randomised comparison of single-incision versus traditional transobturator midurethral sling in women with stress urinary incontinence: results of a 24-month follow-up. Int Urogynecol J 2015; 27:871-7. [DOI: 10.1007/s00192-015-2898-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/15/2015] [Indexed: 12/13/2022]
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19
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Lo TS, Cortes EFM, Wu PY, Tan YL, Pue LB, Al-Kharabsheh A. Clinical outcomes of single-incision sling procedure (MiniArc). Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Bayrak O, Seckiner I, Urgun G, Sen H, Ozcan C, Erturhan S. Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients. Int Braz J Urol 2015; 41:714-21. [PMID: 26401864 PMCID: PMC4757000 DOI: 10.1590/s1677-5538.ibju.2014.0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose: To compare transobturator midurethral sling (TOS) and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2) female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF) and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL). Materials and Methods: In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina) procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA)] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL. Results: There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05). ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively). In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190). Conclusions: The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.
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Affiliation(s)
- Omer Bayrak
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Ilker Seckiner
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Gokhan Urgun
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Haluk Sen
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
| | - Caglayan Ozcan
- Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey
| | - Sakip Erturhan
- Department of Urology , University of Gaziantep, Gaziantep, Turkey
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Serels S. Single incision slings: Past, present, and future. World J Obstet Gynecol 2015; 4:68-71. [DOI: 10.5317/wjog.v4.i3.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/20/2015] [Accepted: 06/19/2015] [Indexed: 02/05/2023] Open
Abstract
Pubovaginal slings have become the gold standard to treat stress urinary incontinence. Traditionally, the sling referred to a suspensory that was placed under the urethra and brought through the retropubic space and anchored on either side of the midline. Since this original concept, there have been many materials used for the sling, and there have been many different anchoring approaches. Most agree that one of the best materials is polypropylene mesh. However, the means of anchoring the device and where best to have this anchorage placed is debatable. The options for anchoring simply include using darts vs not to hold the sling in place. The location of this anchorage, on the other hand, is much more controversial. The main locations are retropubic, transobturator, and via a single incision. The obturator and retropubic slings have become the standard of care over time. The single incision sling, on the other hand, is starting to be more acceptable which has resulted in it being used more frequently. The single incision relies on mainly anchoring the sling through the obturator internus muscle with possible inclusion of the obturator membrane. The purpose of this review article is to present the data that exists for the use of the single incision sling.
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Lee JKS, Rosamilia A, Dwyer PL, Lim YN, Muller R. Randomized trial of a single incision versus an outside-in transobturator midurethral sling in women with stress urinary incontinence: 12 month results. Am J Obstet Gynecol 2015; 213:35.e1-35.e9. [PMID: 25637849 DOI: 10.1016/j.ajog.2015.01.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 01/14/2015] [Accepted: 01/26/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate objective and subjective outcomes of MiniArc and Monarc (American Medical Systems, Minnetonka, MN) midurethral sling (MUS) in women with stress incontinence at 12 months. STUDY DESIGN A total of 225 women were randomized to receive MiniArc or Monarc. Women with intrinsic sphincter deficiency, previous MUS, or untreated detrusor overactivity were excluded. Objective cure was defined as negative cough stress test with a comfortably full bladder. Subjective cure was defined as no report of leakage with coughing or exercise on questionnaire. Validated questionnaires, together with urodynamic and clinical cough stress test, were used to evaluate the objective and subjective outcomes following surgery. Participants and clinicians were not masked to treatment allocation. Outcomes were compared with exact binomial tests (eg, Fisher exact test for dichotomous data) for categorical data and Student t tests or exact versions of Wilcoxon tests for numerical data as appropriate. RESULTS There was no statistically significant difference in the subjective (92.2% vs 94.2%; P = .78; difference, 2.0%; 95% confidence interval, -2.7% to +6.7%) or objective (94.4% vs 96.7%; P = .50; difference, 2.3%; 95% confidence interval, -1.5% to +6.1%) cure rates between MiniArc and Monarc at 12 m, respectively, with a significant improvement in overactive bladder outcomes and incontinence impact from baseline in both arms. CONCLUSION MiniArc outcomes are not inferior to Monarc MUS outcomes at 12 months' follow-up in women without intrinsic sphincter deficiency.
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Affiliation(s)
- Joseph K-S Lee
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia; Pelvic Floor Clinic, Monash Medical Center, Moorabbin, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Anna Rosamilia
- Pelvic Floor Clinic, Monash Medical Center, Moorabbin, VIC, Australia; Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter L Dwyer
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yik N Lim
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Reinhold Muller
- School of Public Health and Tropical Medicine, James Cook University, Townsville, QLD, Australia
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Blewniewski M, Markowski M, Kliś R, Różański W. Mini-slings - an option in stress urinary incontinence treatment. Case studies. Cent European J Urol 2015; 68:68-71. [PMID: 25914841 PMCID: PMC4408381 DOI: 10.5173/ceju.2015.01.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/06/2014] [Accepted: 08/26/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Stress urinary incontinence (SUI) is a social disease caused by numerous contributing factors such as natural childbirth, obesity, hormonal deficiencies and changes in collagen fibers, to name a few. Currently, mini–slings, among all the surgical treatment methods, have gained significance. The aim of this study was to establish the effectiveness of this method. Material and methods From 2008 to 2012, one hundred sixty women suffering from SUI underwent surgical procedures to implant mini–slings under the middle part of the urethra and 140 (87.5%) of them remained under observation. In 65 cases, Johnson & Johnson's TVT–Secur was used; in 70 cases, BARD's Adjust mini–sling was used; and in 5 cases, AMS Mini–Arc mini–sling was used. The average period of hospitalization was 3 days per admission, operation and discharge day. Results In 82 cases, patients urinated well after the removal of the catheter, and had full urine continence. Fourteen patients showed great improvement, and in four cases temporary urine retention was observed. In two cases vaginal bleeding was observed, yet there was no need for wound revision. Evaluation of the ‘quality of life improvement’ was done using the Visual Analog Scale (VAS). Conclusions The obtained results allowed the conclusion that the implantation of mini–slings is a low invasive, relatively safe and effective procedure for the treatment of SUI even in cases of recurrence. Almost full recovery was achieved in all the cases of this study. The mini–sling has become an important element in modern urogynecology.
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Affiliation(s)
| | | | - Rafał Kliś
- 2 Department of Urology, Medical University of Łódź, Poland
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Stress urinary incontinence surgery with sling MiniArc: a 4-year results. Actas Urol Esp 2015; 39:47-52. [PMID: 24796524 DOI: 10.1016/j.acuro.2014.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/05/2014] [Accepted: 03/01/2014] [Indexed: 11/24/2022]
Abstract
OBJETIVES The aim of this publication is to describe retrospectively the results of the surgical technique of AMS MiniArc for the treatment of female urinary incontinence, evaluate its results at 4 years follow-up. MATERIAL AND METHODS We present a retrospective cohort study of 135 patients, 110 (81.5%) had urinary incontinence and 25 (18.5%) mixed urinary incontinence. All these procedures were performed with local anesthesia and in "out patient surgery". Patients were monitored in the outpatient clinic at 6 months (control 1), one year (control 2) and annually (control 3, 4, and 5). During the following up, clinical history was made in every woman with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress with full bladder. We use the SPSS program (V19.0) for statistical analysis of the results. RESULTS The mean follow-up was of 59 months (range from 33 to 72 months). When evaluating the success rate of anti-incontinence surgery, 86.7% of patients showed objective cured (80.8% with MUI and 89.2% with SUI). The ICIQ-SF decreased average of 12.7 points, 85.7% patients were very or fairly satisfied. CONCLUSION The AMS MiniArc is an optim anti-incontinence procedure a medium term. But the results should be interpreted with caution given the limitations of the study.
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26
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Foote A. Randomized prospective study comparing Monarc and Miniarc suburethral slings. J Obstet Gynaecol Res 2014; 41:127-31. [DOI: 10.1111/jog.12493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Foote
- Calvary Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
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27
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Coskun B, Lavelle RS, Alhalabi F, Lemack GE, Zimmern PE. Mini-slings can cause complications. Int Urogynecol J 2014; 26:557-62. [DOI: 10.1007/s00192-014-2530-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/29/2014] [Indexed: 11/24/2022]
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Lo TS, Tan YL, Wu PY, Cortes EFM, Pue LB, Al-Kharabsheh A. Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). Eur J Obstet Gynecol Reprod Biol 2014; 182:91-7. [PMID: 25265496 DOI: 10.1016/j.ejogrb.2014.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI). STUDY DESIGN This was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2 g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking. RESULTS Postoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05). CONCLUSIONS In conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Yiap Loong Tan
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Sarawak General Hospital & Kuching Specialist Hospital (KPJ), Kuching, Sarawak, Malaysia
| | - Pei-Ying Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Eileen Feliz M Cortes
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines
| | - Leng Boi Pue
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Hospital Serdang, Kajang, Selangor, Malaysia
| | - Ahlam Al-Kharabsheh
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, King Abdullah University Hospital/University of Science & Technology, Irbid, Jordan
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Schellart RP, Oude Rengerink K, Van der Aa F, Lucot JP, Kimpe B, de Ridder DJMK, Dijkgraaf MGW, Roovers JPWR. A randomized comparison of a single-incision midurethral sling and a transobturator midurethral sling in women with stress urinary incontinence: results of 12-mo follow-up. Eur Urol 2014; 66:1179-85. [PMID: 25168619 DOI: 10.1016/j.eururo.2014.07.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/21/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Midurethral sling procedures have become the prime surgical treatment for women with stress urinary incontinence (SUI). Single-incision mini-slings (SIMS) potentially offer similar efficacy with reduced morbidity. This international multicenter trial compared the efficacy and morbidity of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS) (Monarc). OBJECTIVE To compare subjective and objective cure, morbidity, and surgery-related discomfort following SIMS and transobturator SMUS. DESIGN, SETTING, AND PARTICIPANTS Prospective randomized controlled trial with an initial follow-up period of 12 mo. Women with symptomatic SUI were eligible. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was subjective cure, defined as an improvement on the Patient Global Impression of Improvement (PGI-I). Coprimary outcome was the mean visual analog scale (VAS) pain score (0-100) during 3 d after surgery. Secondary outcomes were objective cure based on the cough stress test (CST), disease-specific quality of life determined by the Urogenital Distress Inventory (UDI-6) score, surgical parameters, and physical performance during recovery. Analysis was by intent to treat. Differences between the MiniArc and Monarc groups on dichotomous variables were chi-square tested and presented as relative risks (RR) with corresponding 95% confidence intervals. We hypothesized that MiniArc was noninferior to Monarc concerning subjective cure and superior concerning postoperative pain. RESULTS AND LIMITATIONS We randomized 97 women to MiniArc and 96 to Monarc. At 12-mo follow-up, subjective cure was 83% following MiniArc and 86% following Monarc (p=0.46). Objective cure was 89% following MiniArc and 91% following Monarc (p=0.65). The mean pain VAS score during the first three postoperative days was 9 following MiniArc and 22 following Monarc (Mann-Whitney U test, p<0.01). CONCLUSIONS At 1-yr follow-up, MiniArc was noninferior to Monarc with respect to subjective and objective cure and superior with respect to postoperative pain. PATIENT SUMMARY This 1-yr randomized clinical trial showed that MiniArc, a single-incision midurethral sling, is noninferior to Monarc, a transobturator sling, with respect to cure and superior with respect to pain and recovery.
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Affiliation(s)
- René P Schellart
- Department of Obstetrics and Gynecology, Kennemer Gasthuis, Haarlem, The Netherlands.
| | - Katrien Oude Rengerink
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Philippe Lucot
- Department of Obstetrics and Gynecology, Jeanne de Flandre Hôpital, Lille Cedex, France
| | - Bart Kimpe
- Department of Urology, General Hospital Sint Lucas, Bruges, Belgium
| | | | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ, El-Nashar SA, Margulies RU, Gleason JL, Aschkenazi SO, Mamik MM, Ward RM, Balk EM, Sung VW. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 211:71.e1-71.e27. [PMID: 24487005 DOI: 10.1016/j.ajog.2014.01.030] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/22/2013] [Accepted: 01/21/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Understanding the long-term comparative effectiveness of competing surgical repairs is essential as failures after primary interventions for stress urinary incontinence (SUI) may result in a third of women requiring repeat surgery. STUDY DESIGN We conducted a systematic review including English-language randomized controlled trials from 1990 through April 2013 with a minimum 12 months of follow-up comparing a sling procedure for SUI to another sling or Burch urethropexy. When at least 3 randomized controlled trials compared the same surgeries for the same outcome, we performed random effects model metaanalyses to estimate pooled odds ratios (ORs). RESULTS For midurethral slings (MUS) vs Burch, metaanalysis of objective cure showed no significant difference (OR, 1.18; 95% confidence interval [CI], 0.73-1.89). Therefore, we suggest either intervention; the decision should balance potential adverse events (AEs) and concomitant surgeries. For women considering pubovaginal sling vs Burch, the evidence favored slings for both subjective and objective cure. We recommend pubovaginal sling to maximize cure outcomes. For pubovaginal slings vs MUS, metaanalysis of subjective cure favored MUS (OR, 0.40; 95% CI, 0.18-0.85). Therefore, we recommend MUS. For obturator slings vs retropubic MUS, metaanalyses for both objective (OR, 1.16; 95% CI, 0.93-1.45) and subjective cure (OR, 1.17; 95% CI, 0.91-1.51) favored retropubic slings but were not significant. Metaanalysis of satisfaction outcomes favored obturator slings but was not significant (OR, 0.77; 95% CI, 0.52-1.13). AEs were variable between slings; metaanalysis showed overactive bladder symptoms were more common following retropubic slings (OR, 1.413; 95% CI, 1.01-1.98, P = .046). We recommend either retropubic or obturator slings for cure outcomes; the decision should balance AEs. For minislings vs full-length MUS, metaanalyses of objective (OR, 4.16; 95% CI, 2.15-8.05) and subjective (OR, 2.65; 95% CI, 1.36-5.17) cure both significantly favored full-length slings. Therefore, we recommend a full-length MUS. CONCLUSION Surgical procedures for SUI differ for success rates and complications, and both should be incorporated into surgical decision-making. Low- to high-quality evidence permitted mostly level-1 recommendations when guidelines were possible.
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Affiliation(s)
- Megan O Schimpf
- Division of Gynecology and Urogynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI.
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas L Wheeler
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Minita Patel
- Department of Obstetrics and Gynecology, Kaiser Permanente, Roseville, CA
| | - Amanda B White
- Department of Obstetrics and Gynecology, University of Texas Southwestern at Seton Healthcare Family, Austin, TX
| | - Francisco J Orejuela
- Department of Obstetrics and Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX
| | - Sherif A El-Nashar
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Rebecca U Margulies
- Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA
| | - Jonathan L Gleason
- Division of Urogynecology, Department of Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA
| | - Sarit O Aschkenazi
- Department of Urogynecology, ProHealth Care, Women's Center, Medical College of Wisconsin, Waukesha, WI
| | - Mamta M Mamik
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics and Gynecology, New York, NY
| | - Renée M Ward
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Nashville, TN
| | - Ethan M Balk
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA
| | - Vivian W Sung
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI
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Djehdian LM, Araujo MP, Takano CC, Del-Roy CA, Sartori MGF, Girão MJBC, Castro RA. Transobturator sling compared with single-incision mini-sling for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 2014; 123:553-561. [PMID: 24499750 DOI: 10.1097/aog.0000000000000148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of a single-incision mini-sling compared with a transobturator midurethral sling for stress urinary incontinence (SUI) treatment. METHODS This prospective single-center randomized controlled trial involved 130 women with a diagnosis of SUI. Primary outcomes were the objective and subjective cure rates, defined as negative cough stress and pad tests, and satisfaction rates. Quality of life assessed by the Incontinence Quality of Life Questionnaire and the Urogenital Distress Inventory Short Form, operation time, complications, and reoperation rates were also recorded. The efficacy was analyzed using a noninferiority test with a margin of 15%. For the noninferiority test, a P value >.05 rejects the noninferiority hypothesis of the mini-sling. RESULTS Sixty-four patients in the mini-sling group and 56 in the transobturator group completed the 12-month follow-up. The objective cure rates for the mini-sling and the transobturator sling were 68.1% and 81.9% (absolute difference 13.8; 90% confidence interval [CI] 1.5-26.1; P=.439) and the subjective cure rates were 81.1% and 88.5% (absolute difference 7.4%; 90% CI 2.8-17.6; P=.110), respectively. There was a significant improvement in quality of life in both groups. Thigh pain was greater after the transobturator sling, four patients (7.1%) compared with zero (P=.045). The mean operation time was 5 minutes shorter for the mini-sling procedure (P=.000). Five patients (7.8%) in the mini-sling group and one patient (1.8%) in the transobturator group underwent surgical reintervention for persistent SUI (P=.213). CONCLUSION The noninferiority of the mini-sling could not be demonstrated in this study at the 12-month follow-up. The mini-sling was associated with shorter operative time and less postoperative thigh pain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094353.
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Affiliation(s)
- Lucyana M Djehdian
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Mini-arc for the treatment of female stress urinary incontinence: long-term prospective evaluation by patient reported outcomes. ISRN UROLOGY 2014; 2014:659383. [PMID: 24579053 PMCID: PMC3918723 DOI: 10.1155/2014/659383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/11/2013] [Indexed: 02/06/2023]
Abstract
Single-incision slings were introduced in the surgical treatment of female stress urinary incontinence (SUI) to lessen the morbidity associated with traditional midurethral slings. However, long-term reports on patient satisfaction are still scarce. This study describes the outcome of women treated with Mini-Arc at a mean follow-up of 45 months. In a previous report on 105 women with 15-month mean follow-up, 84 (80%) were found cured and 12 (11%) improved. Now, with a mean follow-up of 45 months, cured/improved patients were reassessed by telephone and completed Patient Global Impression of Improvement (PGI-I), Patient Global Impression of Severity (PGI-S), rated their improvement in a 0-100 scale, and answered if they would recommend the procedure. At 45-month follow-up, 73 women cured/improved were available for evaluation. Over 80% of the cured patients rated the improvement of SUI by the PGI-I as "very much better" or "much better," reported their urinary tract condition to be "normal" on PGI-S, and described their improvement >70%. Ninety percent would recommend this procedure to a friend. The improved-patient population is very small (n = 7). This study shows that the majority of patients cured/improved after Mini-Arc placement maintain a high degree of satisfaction at a long-term evaluation.
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Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques. Actas Urol Esp 2013; 37:549-53. [PMID: 23618512 DOI: 10.1016/j.acuro.2012.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/27/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc(®) (single-incision suburethral mini-sling). MATERIAL AND METHODS Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc(®) mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. RESULTS The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc(®), technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc(®), a difference that was statistically significant. CONCLUSION We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.
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Lizée D, Cornu JN, Peyrat L, Ciofu C, Beley S, Haab F. Mini-bandelettes pour le traitement de l’incontinence urinaire d’effort féminine : revue de la littérature. Prog Urol 2013; 23:917-25. [DOI: 10.1016/j.purol.2013.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 01/01/2023]
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Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol 2013; 65:402-27. [PMID: 24055431 DOI: 10.1016/j.eururo.2013.08.032] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/13/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT An updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI). OBJECTIVE To evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI. EVIDENCE ACQUISITION A literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri- and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice. EVIDENCE SYNTHESIS A total of 26 RCTs (n=3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88-1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94-1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: -2.94; 95% CI, -4.16 to -1.73) and earlier return to normal activities and to work (WMD: -5.08; 95% CI, -9.59 to -0.56 and WMD: -7.20; 95% CI, -12.43 to -1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93-4.31). CONCLUSIONS This meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included.
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Castellier C, Doucède G, Debodinance P. [Place of the mini-sling in the treatment of female stress urinary incontinence]. ACTA ACUST UNITED AC 2013; 42:639-46. [PMID: 23973118 DOI: 10.1016/j.jgyn.2013.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Evaluate the place of sub-urethral mini-slings in the treatment of female stress urinary incontinence. MATERIAL AND METHODS Review of the literature on 43 publications (comparative and prospective studies) more than 6443 patients who underwent for the treatment of urinary incontinence, a mini-strip type TVT®, TVT-S®, MiniArc®, Ajust®, Needleless®, Solyx®, or Ophira® in comparison to the conventional urethral sling. The comparison used objective (cough stress test and pad weight test) and subjective criteria (quality of life questionnaire). The papers have also studied the complication associated with these new techniques. RESULTS The overall effectiveness of this surgery varied between 40 to 84% for TVT-S®, 69 to 92% for MiniArc®, 80 to 91% for Ajust®, 87% for Needleless®, 95% for Solyx® and 85% for Ophira®. The efficacy on incontinence was higher with the TVT® TVT-S® and the MiniArc® (P=0.01 to 0.05). TVT-O® efficacy was higher than TVT-S® (P<0.01 and P=0.02). Conventional slings seems to be more efficient than TVT-S® and MiniArc® mini-slings. Ajust® mini-sling seems to be as efficient as MiniArc® and TVT-S® mini-sling and TVT-O®. It showed a decrease in the intensity of postoperative pain (P<0.001), faster return to normal activities (P=0.025) and use of a common local anesthetic to the adjustable mini-sling. CONCLUSION It seems that the adjustable mini-sling is currently the best compromise in terms of effectiveness and complications if the choice had to be among the mini-sling in the treatment of stress urinary incontinence.
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Affiliation(s)
- C Castellier
- Département de gynécologie-obstétrique, centre hospitalier Dunkerque, GCS Flandre-Maritime, avenue de la Polyclinique, 59760 Grande-Synthe, France
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Ahn KH, Alvarez J, Dwyer PL. Recent Developments in the Surgical Management of Urinary Stress Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Basu M, Duckett J. Three-year results from a randomised trial of a retropubic mid-urethral sling versus the Miniarc single incision sling for stress urinary incontinence. Int Urogynecol J 2013; 24:2059-64. [PMID: 23712578 DOI: 10.1007/s00192-013-2125-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/28/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There are limited long-term efficacy data on single-incision slings. The primary aim of this study was to evaluate the success rate of a single-incision sling versus a retropubic mid-urethral sling for cure of SUI at 3 years' follow-up, in order to assess whether there is a deterioration in efficacy over time. The secondary aims were to assess re-operation rates for each procedure and to evaluate any differences in disease-specific quality of life. METHODS This study was a 3-year questionnaire-based follow-up of a randomised controlled trial of the Miniarc single-incision sling versus the Advantage retropubic mid-urethral sling. Patients were considered failures if they documented stress incontinence on the symptom domain of the King's Health questionnaire (KHQ) or had undergone repeat surgery for stress incontinence. RESULTS Follow-up was available from 35 out of 38 women in the single-incision sling group (92.1 %) and from 26 out of 33 in the retropubic mid-urethral sling group (79.0 %). The overall 3-year failure rate was 20 out of 38 (52.6 %) in the single-incision sling group and 3 out of 33 (9.0 %) in the retropubic mid-urethral sling group (odds ratio 10.0, 95 % confidence interval 2.6-38.4). In the single-incision sling group, the failure rate increased from 40.5 % at 6 months to 52.6 % at 3 years with corresponding figures of 3 to 9 % in the retropubic mid-urethral sling group. CONCLUSIONS In this study, there was a significantly higher 3-year failure rate for the single-incision sling versus the retropubic mid-urethral sling. Both procedures had reduced efficacy over time.
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Affiliation(s)
- Maya Basu
- Department of Urogynaecology and Pelvic Reconstructive Surgery, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK,
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A comparative study of a single-incision sling and a transobturator sling: clinical efficacy and urodynamic changes. Int Urogynecol J 2012; 24:823-9. [PMID: 23052630 DOI: 10.1007/s00192-012-1942-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In this retrospective study, a comparison is made of the clinical efficacy of two stress urinary incontinence treatment apparatuses, a single-incision sling and a transobturator sling. METHODS Eighty-five (single-incision n=43, transobturator n=42) consecutive patients were included in this study. Clinical outcomes were assessed by the cough stress test (CST), the pad test, the Impact Questionnaire-Short Form (IIQ-7), the Urogenital Distress Inventory six-item questionnaire (UDI-6), the Sexual Questionnaire-SF (PIS-Q), the pain score, and the postoperative changes in urodynamic parameters. A comparison of the 1-year follow-up data is presented. RESULTS Three months post-surgery, 81.8% of the single-incision sling group and 74.4% of the transobturator sling group had a negative cough test and a dry pad test. One year after surgery, significantly decreasing UDI-6, IIQ-7, and increasing PIS-Q scores were observed in both groups, while the complication rates remained similar. Postoperatively, the single-incision sling group seems to show a greater improvement in UDI-6 score, require less operation time, and experience less blood loss, less postoperative pain, and a smaller decrease in maximal urethral closure pressure (MUCP). CONCLUSIONS These results suggest that the single-incision sling and the transobturator sling are equally as effective and safe for the treatment of stress incontinence, as evaluated during the 1-year follow-up. The insertion of a single-incision sling seems to be less painful than that of a conventional sling. One year after surgery, the MUCP and mean flow rate of the transobturator sling group had significantly decreased compared with that of the single-incision sling group.
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Moore RD, De Ridder D, Kennelly MJ. Two-year evaluation of the MiniArc in obese versus non-obese patients for treatment of stress urinary incontinence. Int J Urol 2012; 20:434-40. [PMID: 22989174 DOI: 10.1111/j.1442-2042.2012.03147.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/12/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Obesity is a well-established risk factor of stress urinary incontinence, which affects up to 35% of adult women worldwide. We evaluated whether there is a difference in outcomes with MiniArc sling for treatment of stress incontinence in obese women versus non-obese women at 24 months. METHODS A 2-year subanalysis of obese (body mass index >30 kg/m(2) ) versus non-obese patients enrolled into a multicenter, prospective study evaluating the effectiveness of MiniArc sling was carried out. Qualitative (Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7) and quantitative measurements, including the cough stress test, were carried out. Secondary outcome measures included procedure time, estimated blood loss, length of stay, perioperative complications, Wong-Baker Faces Pain Scale and adverse events. RESULTS Of 188 patients, 62 were obese. The mean procedure time, blood loss and length of stay were no different between groups. Obese patients reported significantly more pain immediately postoperatively (2 vs 1, Wong-Baker, P = 0.042), but there was no difference at postoperative day 7. There was no difference in objective cure using the cough stress test (81% obese vs 86% non-obese; P = 0.449). Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7 median scores showed no difference between groups in improvement (P = 0.126 and P = 0.087, respectively). No serious device-related complications were reported in either group. CONCLUSIONS The MiniArc sling represents a safe and effective treatment option for both obese and non-obese patients with stress incontinence. Comparable outcomes at 2 years can be obtained in terms of cure rates using the cough stress test or questionnaires, as well as complication rates.
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Affiliation(s)
- Robert D Moore
- Atlanta Urogynecology Associates, Atlanta, GA 30005, USA.
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Naumann G, Hagemeier H, Albrich S, Skala C, Koelbl H, Laterza R. Patient goals after incontinence procedures: does the single-incision sling satisfy them? Eur J Obstet Gynecol Reprod Biol 2012; 163:234-7. [DOI: 10.1016/j.ejogrb.2012.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 04/25/2012] [Indexed: 11/28/2022]
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Efficacy of TVT-SECUR and factors affecting cure of female stress urinary incontinence: 3-year follow-up. Int Urogynecol J 2012; 23:1721-6. [PMID: 22584924 DOI: 10.1007/s00192-012-1809-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/17/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to evaluate the efficacy of the TVT-SECUR procedure for treating stress urinary incontinence (SUI) and to identify factors affecting cure during 3 years of follow-up. METHODS We prospectively followed patients until 1 year postoperatively and contacted them to revisit the clinic at 3 years. Ninety-six women who underwent TVT-SECUR (H type: 42, U type: 54) were followed up for at least 3 years. Patients were evaluated using the Severity Index for Urinary Incontinence, the Incontinence Quality of Life questionnaire, and the Bristol Female Lower Urinary Tract Symptom-Short Form questionnaire at baseline and at each postoperative visit. Patient satisfaction and complications were evaluated. Surgical outcome was assessed according to the Severity Index for Urinary Incontinence. Multivariate regression analysis was used to identify preoperative factors independently associated with cure. RESULTS The 3-year success rate was 91.7 % (cure 72.9 %, improved 18.8 %). The success rate was maintained from 94.8 % at 1 year to 91.7 % at 3 years, but the cure rate decreased significantly from 85.4 % at 1 year to 72.9 % at 3 years. Patient satisfaction rate was 85.4 %. Cure rates were lower in patients with Valsalva leak point pressure (VLPP) <60 cmH(2)O (79.5 % vs. 52.2 %, p = 0.010). Multivariate analysis showed that only low VLPP was associated with a lower cure rate. CONCLUSIONS The cure rate of female SUI after the TVT-SECUR procedure was not sustained, but the overall success rate was maintained over time. Low VLPP predicted failure to sustain cure.
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A randomized controlled trial comparing three vaginal kits of single-incision mini-slings for stress urinary incontinence: surgical data. Eur J Obstet Gynecol Reprod Biol 2012; 163:108-12. [PMID: 22552180 DOI: 10.1016/j.ejogrb.2012.03.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/05/2012] [Accepted: 03/29/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Single-incision mini-slings (SIMS) are new minimally invasive devices used for female stress urinary incontinence (SUI). To date, several SIMS are available, but few and uncontrolled comparative data have assessed their safety and feasibility. The aim of the present clinical study was to compare three different SIMS in an ambulatory setting. STUDY DESIGN One hundred and twenty patients with SUI were randomized to receive three SIMS: Ajust, MiniArc, and TVT Secur System. Surgical data were compared. RESULTS Significantly (P<0.05) lower surgical difficulty and higher patient satisfaction were detected in the MiniArc group when compared to the Ajust and TVT Secur System groups. A significantly (P<0.05) higher feasibility under local anesthesia and in ambulatory setting was also detected for the MiniArc group. The overall complication rate was significantly (P<0.05) lower in the MiniArc group than in the TVT Secur System group. CONCLUSIONS MiniArc is simpler to insert under local anesthesia and in an ambulatory setting. It is safer than the TVT Secur System, and is related to higher patient satisfaction.
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Kennelly MJ, Moore R, Nguyen JN, Lukban J, Siegel S. Miniarc single-incision sling for treatment of stress urinary incontinence: 2-year clinical outcomes. Int Urogynecol J 2012; 23:1285-91. [PMID: 22527540 DOI: 10.1007/s00192-012-1734-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 03/04/2012] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We report 2-year data on the effectiveness and safety of the MiniArc single-incision sling in women with stress urinary incontinence. METHODS This multi-center, prospective, single-arm, industry-sponsored study measured the effectiveness of the MiniArc sling via quantitative (cough stress test and 1-h pad weight test) and qualitative (Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form) measurements. The objective efficacy rate was defined as the number of patients with a negative cough stress test or 1-h pad weight test ≤ 1 g at 2 years. The subjective efficacy rate was determined by patient responses to the UDI-6 question # 3, "Do you experience, and if so, how much are you bothered by urine leakage related to physical activity, coughing, or sneezing?" Secondary objectives were to evaluate procedural variables of implantation and long-term safety. RESULTS One hundred and eighty women with a mean age of 51.1 years were implanted in the study. Mean procedure time, blood loss, and length of stay were 11.0 min, 41.7 mL and 9.5 h respectively. At 2 years, 142 patients were available for analysis. The objective efficacy rates for the cough stress test (CST) and pad weight test (PWT) were 84.5 % and 80.1 % respectively and the subjective efficacy rate was 92.9 %. Median Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form scores showed statistically significant improvement (p < .001). The most common adverse events included UTI (4.8 %), constipation (3.7 %), and temporary urinary retention (3.2 %). CONCLUSION MiniArc is a safe and effective surgical procedure for the treatment of SUI in women with follow-up through 2 years.
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Affiliation(s)
- Michael J Kennelly
- Department of Urology, Carolinas Medical Center, Charlotte, NC 28207, USA.
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Shah HN, Badlani GH. Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review. Indian J Urol 2012; 28:129-53. [PMID: 22919127 PMCID: PMC3424888 DOI: 10.4103/0970-1591.98453] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude, severity and potential recurrence of pelvic floor defect.
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Affiliation(s)
- Hemendra N. Shah
- Wake Forest University School of Medicine, Department of Urology, Medical Center Boulevard, Winston-Salem, NC, country USA
| | - Gopal H. Badlani
- Wake Forest University School of Medicine, Department of Urology, Medical Center Boulevard, Winston-Salem, NC, country USA
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Naumann G, Albrich S, Skala C, Laterza R, Kölbl H. Single-Incision Slings (SIS) - a New Option for the Surgical Treatment of Female Stress Urinary Incontinence. Geburtshilfe Frauenheilkd 2012; 72:125-131. [PMID: 25284829 PMCID: PMC4168529 DOI: 10.1055/s-0031-1298275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 12/11/2011] [Accepted: 12/02/2011] [Indexed: 10/28/2022] Open
Abstract
The new development of single-incision slings (SIS) for the treatment of female stress urinary incontinence offers comparable results with only minimal side effects and will find wide acceptance in modern incontinence surgery. This mini-sling is inserted over a single vaginal incision and fixed on both sides to the pelvic wall tissue with special anchors, without passing through the groin and avoiding a blind tape passage. Compared with the established sub-urethral tapes, there are comparable success rates with fewer complications. Randomised prospective studies are needed to evaluate whether, in the long run, the benefits of the single incision technique can be correlated with satisfying continence results.
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Affiliation(s)
- G. Naumann
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Mainz
| | - S. Albrich
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Mainz
| | - C. Skala
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Mainz
| | - R. Laterza
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Mainz
| | - H. Kölbl
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Mainz
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Abstract
Understanding sample size calculation is vitally important for planning and conducting clinical research, and critically appraising literature. The purpose of this paper is to present basic statistical concepts and tenets of study design pertaining to calculation of requisite sample size. This paper also discusses the significance of sample size calculation in the context of ethical considerations. Scenarios applicable to urology are utilized in presenting concepts.
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Affiliation(s)
- Peter Hinh
- Division of Urology, University of Texas Medical School at Houston, Houston, Texas, USA
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The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up. Int Urogynecol J 2011; 23:589-95. [PMID: 22109702 PMCID: PMC3332378 DOI: 10.1007/s00192-011-1605-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 10/28/2011] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence. Methods Seventy-seven patients, operated on from March 2008 to November 2009, were evaluated in this study. One-year post-operative data are presented. All patients suffered from predominant stress urinary incontinence. After 1 year, response was 74%. Evaluation was performed using a questionnaire consisting of the EuroQol-5 Dimensions, the Patient Global Impression of Improvement, the Incontinence Impact Questionnaire, the Urinary Distress Inventory, the Prolapse/Urinary Incontinence Sexual Questionnaire, short form, and the Defecation Distress Inventory. Results One year after surgery, 68% of the patients stated an improvement in their incontinence status, while only 44% stated to be completely dry. Conclusion The 1-year follow-up suggests that the MiniArc is less effective in the treatment of stress urinary incontinence than the TVT.
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Bernasconi F, Napolitano V, Natale F, Leone V, Lijoi D, Cervigni M. TVT SECUR™ System: Final results of a prospective, observational, multicentric study. Int Urogynecol J 2011; 23:93-8. [DOI: 10.1007/s00192-011-1520-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 07/12/2011] [Indexed: 11/24/2022]
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Kennelly MJ, Myers EM. Retropubic and transobturator slings: still useful or should all patients be treated with mini-slings? Curr Urol Rep 2011; 12:316-22. [PMID: 21698397 DOI: 10.1007/s11934-011-0200-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traditional retropubic and transobturator midurethral slings are reliable, safe, and effective treatments for stress urinary incontinence. Unfortunately, they also are associated with rare but severe complications, such as bladder or bowel perforation, vascular injury, nerve damage, and/or groin muscle pain that can occur with the blind passage of trocars. To maintain efficacy and patient satisfaction while avoiding such complications, minimally invasive mini-slings have been developed. These smaller mini-slings can be placed through a single vaginal incision at the level of the midurethra without trocars. Mini-slings often are performed as an outpatient surgery, with minimal morbidity, pain, and quick patient recovery. With continued refinement and surgeon experience, mini-slings potentially may be performed safely in the office setting under local anesthesia while maintaining the efficacy of traditional slings.
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Affiliation(s)
- Michael J Kennelly
- Charlotte Continence Center, McKay Department of Urology, 1023 Edgehill Road South, Charlotte, NC 28207, USA.
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