A cohort study comparing a single-incision sling with a retropubic midurethral sling

Three-year patient-reported outcomes of single-incision versus transobturator slings for female stress urinary incontinence are equivalent

INTRODUCTION AND HYPOTHESIS

Patient-reported outcome measures (PROMs) are important for understanding the success of surgery for stress urinary incontinence, as patient perception of success does not always correlate with physician perception of success. We report PROMS after single-incision slings (SIS) and transobturator mid-urethral slings (TMUS).

METHODS

This was a planned outcome analysis of secondary endpoints in a study in which the primary aim was to compare efficiency and safety using a non-inferiority design (results reported previously). In this analysis of quality of life (QOL), validated PROMs were collected at baseline, 6, 12, 18, 24, and 36 months to quantify incontinence severity (Incontinence Severity Index), symptom bother (Urogenital Distress Inventory), disease-specific QOL impact (Urinary Impact Questionnaire), and generic QOL impact (PGI-I; not applicable at baseline). PROMs were analyzed within treatment groups as well as between groups. Propensity score methods were used to adjust for baseline differences between groups.

RESULTS

A total of 281 subjects underwent the study procedure (141 SIS, 140 TMUS). Baseline characteristics were balanced after propensity score stratification. Participants had significant improvement in incontinence severity, disease-specific symptom bother, and QOL impact. Improvements persisted through the study and PROMs were similar between treatment groups in all assessment at 36 months CONCLUSIONS: Following SIS and TMUS, patients with stress urinary incontinence had significant improvement in PROMs including Urogenital Distress Inventory, Incontinence Severity Index, and Urinary Impact Questionnaire at 36 months, indicating disease-specific QOL improvement. Patients have a more positive impression of change in stress urinary incontinence symptoms at each follow-up visit, indicating generic QOL improvement.

Adjustable slings versus other surgical methods in female stress urinary incontinence: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

The objective of this study was to evaluate the efficacy and safety of different adjustable slings compared to other surgical methods for the treatment of stress urinary incontinence (SUI) among women.

METHODS

The inclusion criteria were as follows: randomized controlled trials (RCTs) and non-RCTs assessing adult women with SUI. The exclusion criteria were as follows: other types of urinary incontinence, studies that combined conservative interventions and pharmacological treatment, pregnant and lactating patients. Databases were searched up to November 2022 to identify articles evaluating the effectiveness and safety of different adjustable slings compared to other surgical methods for the treatment of SUI among women. The systematic review was conducted in accordance with the PRISMA 2020 checklist and registered in PROSPERO. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the included studies.

RESULTS

Eighteen clinical trials were included in this systematic review, and 11 studies were included in the meta-analysis. Fourteen studies were RCTs, and four were retrospective studies. Only RCTs were included in the meta-analyses. There was no statistically significant difference in the objective cure rate, subjective cure rate, or long-term postoperative complication rate between Ajust single-incision mini-slings (SIMS) and standard mid-urethral slings (SMUS) or MiniArc SIMS. However, the operation time in the adjustable SIMS group was significantly shorter (RR = -4.20, 95% CI: [-7.51, -0.89], p = 0.01).

CONCLUSIONS

This systematic review and meta-analysis revealed that adjustable SIMS is equally effective when compared with SMUS for the treatment of SUI among women. Moreover, the operation time for the adjustable SIMS was shorter. However, additional well-designed studies with standard outcome measures and complete follow-up periods will help to increase confidence in the choice of different options for treating SUI among women.

Comparison of Two Single-Incision Mini-Slings for the Treatment of Incontinence

INTRODUCTION

This study aimed to compare the safety and efficacy of 2 single-incision mini-sling (SIMS) systems with different designs of anchoring mechanism.

METHODS

The records of patients who have been operated for the treatment of female stress urinary incontinence (SUI) with 2 different SIMS systems were retrospectively evaluated. Patient characteristics, physical examination results, and quality of life (QoL) questionnaires were used to evaluate the patients. Primary efficacy endpoints were the cure and failure rates. Secondary efficacy endpoints were complications and differences in QoL questionnaires.

RESULTS

Eighty-three patients from group 1 (Ophira SIMS system) and 77 patients from group 2 (Gallini SIMS system) were evaluated. There was no significant difference between the 2 groups regarding patient characteristics. The objective cure rates were found to be 83.1 and 79.2% in group 1 and group 2, respectively (p = 0.09). Mesh-related complications, such as anchor displacement, bladder erosion, vaginal erosion, and groin pain, were more common in group 1. No severe complications were observed. For both groups, a significant improvement in all scores of QoL questionnaires was observed after surgery; however, the differences between 2 groups were not significant.

CONCLUSIONS

The present study showed that the treatment of female SUI with 2 different SIMS systems had similar efficacy, complication rates, and scores in QoL questionnaires.

Single-incision midurethral sling shows less pain and similar success rate in a short-term follow-up compared to the transobturator tape method in the treatment of stress urinary incontinence

OBJECTIVE

To compare the efficacy, complications, quality of life, and patient satisfaction rates in women treated for stress urinary incontinence (SUI) using the adjustable anchored single-incision midurethral sling (SIMS) and standard midurethral sling (MUS) procedures.

MATERIAL AND METHODS

A total of 113 women between October 2012 and October 2016 underwent either the adjustable SIMS (n=54) or MUS (n=57) procedure. The postoperative pain profile was assessed using a 10-point visual analog scale at the fixed time-point quality of life and an additional postoperative 3^rd week appointment. We asked our patients the following two questions to evaluate their satisfaction with surgery and their preference: "Would you have this kind of surgery again?" (Q1), and "Would you recommend this type of surgery to another patient with same symptoms?" (Q2). For the evaluation of patient complaints, the Incontinence Impact Questionnaire (IIQ-7) and Urinary Distress Inventory (UDI-6) were used before and after the procedure.

RESULTS

Women in the SIMS group had a significantly lower postoperative pain profile for up to 3 weeks (p<0.001). There was no significant difference in perioperative complications and postoperative continence rates between the groups. With regard to Q1 and Q2, a significant difference was found between the groups (p=0.003 and p=0.002, respectively). While the questionnaire scores of the IIQ-7 and UDI-6 were also significantly improved at postoperative evaluations (p<0.001), there was no significant difference between the two groups.

CONCLUSION

SIMS is associated with a significantly improved postoperative pain profile and earlier return to work when compared to MUS.

Guideline-Based Strategies in the Surgical Treatment of Female Urinary Incontinence: The New Gold Standard is Almost the Same as the Old One

The modern sling procedures for treating female stress urinary incontinence encompass numerous methods, materials and manufacturers. On the basis of the current S2e guidelines, the methods used most frequently in the diagnosis of and therapy for stress urinary incontinence in women are critically illustrated. An individualised procedure is necessary for the choice of the surgical method, especially in the presence of accompanying pathologies. This article is intended to help the treating physician to carry out quality-assured diagnostics and therapy for the patient and to offer the best possible urogynaecological management. In addition to the complications and chances of success of the surgical options, the legal aspects of therapy planning are also taken into consideration.

Single incision slings: Past, present, and future

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.

Heterogeneity in post-intervention prolapse and urinary outcome reporting: a one-year review of the International Urogynecology Journal

INTRODUCTION

This review aimed to examine post-intervention prolapse, incontinence, and overactive bladder outcome measures published in the International Urogynecology Journal over the previous year and to report on the heterogeneity in outcome reporting.

METHODS

All original article abstracts published in the print version of the International Urogynecology Journal in 2014 were reviewed for possible inclusion. Those reporting on prolapse and/or incontinence and/or overactive bladder outcomes following a urogynecological intervention were analyzed. Articles were reviewed for all reported outcomes. Outcomes were categorized as primary or secondary and objective or subjective.

RESULTS

Of 117 original articles published, 45 were reviewed. Among primary outcomes, 9 different outcomes were reported for prolapse and 11 for incontinence and overactive bladder. For prolapse, 6 different objective and 13 subjective outcomes were reported. For incontinence, 21 objective and 36 subjective outcomes were reported. Three different definitions were used for the outcome of "prolapse cure," 3 for "prolapse recurrence," and 4 for "stress incontinence cure." Several validated and non-validated questionnaires in addition to single unvalidated questions were used to measure subjective outcomes.

CONCLUSIONS

This research highlights the diversity in outcome reporting for prolapse, incontinence, and overactive bladder after an intervention in the last year of publications alone. This can lead to serious challenges in the generation of higher order evidence, such as systematic reviews and meta-analyses. As a subspecialty, we need to aim for more cohesive reporting so as to allow for robust comparison and evidence dissemination.

Diagnosis and surgical treatment of stress urinary incontinence

Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation's female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort.