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Peyronnet B, Chartier-Kastler E. Artificial urinary sphincter is the best treatment for persistent or reccurent stress urinary incontinence after midurethral sling in female patients: Pro. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102594. [PMID: 38382242 DOI: 10.1016/j.fjurol.2024.102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Benoit Peyronnet
- Department of Urology, Hospital Pontchaillou, University of Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France
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Sears S, Rhodes S, McBride C, Shoag J, Sheyn D. Complications following retropubic versus transobturator midurethral synthetic sling placement. Int Urogynecol J 2023; 34:2389-2397. [PMID: 37133561 DOI: 10.1007/s00192-023-05553-x] [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: 12/09/2022] [Accepted: 03/29/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Transobturator slings (TOS) are inferior to retropubic slings (RPS) based on long-term outcomes; data on complications is critical for patient counseling. We hypothesized rates of urinary retention would be higher for RPS, while pain and repeat sling surgery would be higher for TOS. METHODS Using the Premier healthcare database we identified encounters for patients undergoing a midurethral sling procedure between 2010 and 2020. Patients were stratified by sling type, either RPS or TOS. The primary outcome was the difference in the composite complication rate between groups within 12 months. Statistical analysis was performed using Kruskal Wallis test for continuous variables and χ2-test for categorical variables. Multivariable logistic regression was used to determine risk factors for complications and risk of specific complications after sling placement. RESULTS 36,991 patients were included in the RPS group and 16,371 in the TOS group. 7,880 patients (14.8%) had at least one sling specific complication. On multivariable logistic regression, RPS patients were more likely to have urinary retention (OR 1.29, 95%CI 1.16-1.43), sling lysis/excision (OR 1.29, 95%CI 1.10-1.53), and hematoma/hemorrhage (OR 1.82, 95%CI 1.16-2.86); they were less likely to have a UTI (OR 0.88, 95%CI 0.82-0.96) or repeat sling (OR 0.60, 95%CI 0.46-0.78). In patients with urinary retention, RPS patients were more likely to undergo sling lysis than TOS (p = 0.012). CONCLUSIONS Significant complications after midurethral synthetic sling are overall rare. RPS are associated with a higher rate of perioperative bleeding and sling lysis/excision due to urinary retention, but less likely to be associated with UTI and treatment failure.
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Affiliation(s)
- Sarah Sears
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Cathryn McBride
- Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, TN, USA
| | - Jonathan Shoag
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - David Sheyn
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Kolek P, Duchonova T, Sedlacek R, Masata J. Could infiltration anesthesia decrease anchor-fixation quality of midurethral slings in the obturator complex? Int Urogynecol J 2023; 34:2381-2387. [PMID: 37133560 DOI: 10.1007/s00192-023-05558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Single-incision miduretral slings (SIMS) were withdrawn from the market in many countries due to lower efficacy. In some countries they are still in use, preferred primarily because it is possible to perform the procedure under local anesthesia. Based on our previous clinical experience we postulated that local anesthesia decreased primary anchor fixation in the obturator complex. The aim of the study is to assess how local infiltration anesthesia influences anchor fixation of the tape in porcine obturator complex. METHODS The experiment was designed to determine the maximum force necessary to extract an implant anchor from a porcine obturator complex. The implant was extracted at a constant speed and data sampling frequency, and the data on displacement of the testing system, achieved force and time were recorded. The implant arms were divided into groups on the right and left sides. In the first group, the anchored arms were used for two implantations - primary and secondary without infiltration anesthesia - and in the second group they were used in the same way, using infiltration anesthesia. RESULTS A total of 40 implanted anchors were tested in the experiment, totaling ten single-incision slings (each anchor was implanted twice). An average of 8.28 N (Newton) (SD 6.73, min. 2.11, max. 30.34 N) is required to remove the implant anchor from the obturator complex without infiltration by local anesthesia. An average force of 4.40 N (SD 2.99 min. 1.2, max. 9.48) is required to remove the anchor from the obturator complex after infiltration. Local anesthesia reduces anchor fixation in the obturator complex by 47%. CONCLUSIONS The local infiltrative anesthesia decreases anchor fixation in the porcine obturator complex.
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Affiliation(s)
- Petr Kolek
- Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Obstetrics and Gynecology, Thomayer University Hospital in Prague, Prague, Czech Republic
| | - Tereza Duchonova
- Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Radek Sedlacek
- Laboratory of Biomechanics, Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jaromir Masata
- Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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Kaufman RE, Vu A, Ufondu O, Powell M, Lanzer J, Terris MK. Late-presenting with a tumor-like mass giant cell reaction related to retropubic midurethral sling. Urol Case Rep 2023; 50:102468. [PMID: 37719190 PMCID: PMC10504477 DOI: 10.1016/j.eucr.2023.102468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023] Open
Abstract
Stress urinary incontinence (SUI) is a condition that most commonly affects aging women. Synthetic mid-urethral slings (MUS) have become the most common surgical treatment for SUI; however, complications such as mesh erosion and dyspareunia have been reported. This case report describes an 84-year-old female who presented with a tumor-like mass giant cell reaction surrounding the MUS and the management of this mass.
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Affiliation(s)
| | - Amelia Vu
- Medical College of Georgia at Augusta University, United States
| | - Obiora Ufondu
- Medical College of Georgia at Augusta University, United States
- Department of Pathology, United States
| | - Matthew Powell
- Medical College of Georgia at Augusta University, United States
- Department of Pathology, United States
| | - Jennifer Lanzer
- Medical College of Georgia at Augusta University, United States
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, United States
| | - Martha K. Terris
- Medical College of Georgia at Augusta University, United States
- Department of Urology, United States
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Salo H, Sova H, Laru J, Talvensaari-Mattila A, Nyyssönen V, Santala M, Piltonen T, Koivurova S, Rossi HR. Long-term results of a prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in stress urinary incontinence. Int Urogynecol J 2023; 34:2249-2256. [PMID: 37074367 PMCID: PMC10506929 DOI: 10.1007/s00192-023-05527-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/10/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at investigating the long-term effectiveness of minimally invasive mid-urethral sling (MUS) surgery and at comparing the outcomes between retropubic (tension-free vaginal tape, TVT) and transobturator tape (TOT) methods in the treatment of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with a predominant stress component in a long-term follow-up of a randomized controlled trial. METHODS This work is a long-term follow-up study of a previous prospective randomized trial conducted in the Department of Obstetrics and Gynecology at Oulu University Hospital between January 2004 and November 2006. The original 100 patients were randomized into the TVT (n=50) or TOT (n=50) group. The median follow-up time was 16 years, and the subjective outcomes were evaluated using internationally standardized and validated questionnaires. RESULTS Long-term follow-up data were obtained from 34 TVT patients and 38 TOT patients. At 16 years after MUS surgery, the UISS significantly decreased from a preoperative score in the TVT (11.88 vs 5.00, p<0.001) and TOT (11.05 vs 4.95, p<0.001) groups, showing a good long-term success of the MUS surgery in both groups. In comparing the TVT and TOT procedures, the subjective cure rates did not differ significantly between the study groups in long-term follow-up according to validated questionnaires. CONCLUSION Midurethral sling surgery had good long-term outcomes in the treatment of SUI and MUI with a predominant stress component. The subjective outcomes of the TVT and TOT procedures were similar after a 16-year follow-up.
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Affiliation(s)
- Heini Salo
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Henri Sova
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Johanna Laru
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Anne Talvensaari-Mattila
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Virva Nyyssönen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Markku Santala
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Henna-Riikka Rossi
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland.
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Yalcin K. Comparison of success, complication and satisfaction rates of TOT and TVT-O surgical techniques. Niger J Clin Pract 2023; 26:1147-1151. [PMID: 37635609 DOI: 10.4103/njcp.njcp_64_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Two different surgical techniques "inside-out" and "outside-in" have been described for transobturator tape procedure, one of the most preferred methods for the surgical treatment of stress urinary incontinence in the last ten years. This study aimed to compare the success, complication, and patient satisfaction rates related to both techniques in patients who underwent transobturator tape procedure due to stress urinary incontinence in a 21-month period. Patients and Method A total of 71 patients including 46 patients who underwent transobturator tape operation with "outside-in" technique and 25 patients who underwent tension-free vaginal tape obturator operation with "inside-out" technique were involved in this study. Patients were evaluated in aspect of postoperative complications, pelvic examination results, stress test results, satisfaction, and quality of life scales. Results Patients operated with both techniques were similar in terms of age, body mass index 15, and menopausal status. Considering the complication rates, dyspareunia was found to be higher in the group using the inside-out technique (p = 0.002). Operation success rates were similar in the two surgical techniques both in subjective and objective evaluation. In addition, although there were differences between the two groups in terms of patient satisfaction rate and quality of life score, overall satisfaction rates were found to be high. Conclusion Transobturator tape operation is a procedure that provides high success rates in the treatment of stress urinary incontinence regardless of the used technique. Operation success rates, patient satisfaction rates, and postoperative quality of life scores were found to be almost similar in both surgical techniques.
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Affiliation(s)
- K Yalcin
- Department of Urology, Tokat Medikal Park Hospital, Urology Clinic, Tokat, Turkey
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Alexandridis V, Lundmark Drca A, Ek M, Westergren Söderberg M, Andrada Hamer M, Teleman P. Retropubic slings are more efficient than transobturator at 10-year follow-up: a Swedish register-based study. Int Urogynecol J 2023:10.1007/s00192-023-05506-4. [PMID: 36995417 DOI: 10.1007/s00192-023-05506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/07/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Long-term performance of mid-urethral slings (MUS) and potential differences between the retropubic and the transobturator technique for insertion are scarcely studied. This study aims to evaluate the efficacy and safety 10 years after surgery and compare the two main surgical techniques used. METHODS Women who underwent surgery with a MUS between 2006 and 2010 were identified using the Swedish National Quality Register of Gynecological Surgery and were invited 10 years after the operation to answer questionnaires regarding urinary incontinence and its impact on quality-of-life parameters (UDI-6, IIQ-7) and impression of improvement, as well as questions regarding possible sling-related complications and reoperation. RESULTS The subjective cure rate reported by 2421 participating women was 63.3%. Improvement was reported by 79.2% of the participants. Women in the retropubic group reported higher cure rates, lower urgency urinary incontinence rates and lower UDI-6 scores. No difference was shown between the two methods regarding complications, reoperation due to complications or IIQ-7 scores. Persisting sling-related symptoms were reported by 17.7% of the participants, most commonly urinary retention. Mesh exposure was reported by 2.0%, reoperation because of the tape by 5.6% and repeated operation for incontinence by 6.9%, significantly more in the transobturator group (9.1% vs. 5.6%). Preoperative urinary retention was a strong predictor for impaired efficacy and safety at 10 years. CONCLUSIONS Mid-urethral slings demonstrate good results for the treatment of stress urinary incontinence and tolerable complication profiles in a 10-year perspective. The retropubic approach displays higher efficacy than the transobturator, with no difference regarding safety.
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Affiliation(s)
- Vasileios Alexandridis
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Obstetrics and Gynecology, Jan Waldenströms gata 47, 205 02, Malmö, Sweden.
| | - Anna Lundmark Drca
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Marion Ek
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Pia Teleman
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Lou Y, Hu Y, Zhou Y. Pelvic ultrasound finding of late-onset bladder erosion after transobturator tape for female stress urinary incontinence: A case report. Medicine (Baltimore) 2023; 102:e33129. [PMID: 36862893 PMCID: PMC9981393 DOI: 10.1097/md.0000000000033129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Mid-urethral sling is a gold-standard procedure for stress urinary incontinence because of its high efficacy and low complication incidence. Moreover, mesh erosion into the bladder is a rare complication. PATIENT CONCERNS The 63-year-old patient visited our gynecology clinic with complaints of gross hematuria and was diagnosed with bladder erosion by ultrasound 6 months after transobturator tape procedure. DIAGNOSES The 2D ultrasound found the sling in the bladder wall perforation, which can lead to the formation of bladder stones. Meanwhile, 3D ultrasound showed the left side of the sling crossed the bladder mucosa at 5 o'clock. INTERVENTIONS The sling and bladder stones were removed by holmium laser. OUTCOMES The patient underwent a follow-up pelvic ultrasound at 6 months, which showed no erosion mesh under the bladder mucosa. LESSONS Pelvic ultrasound could accurately evaluate the location and shape of the tape, which is important for a reasonable surgical plan.
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Affiliation(s)
- Yelin Lou
- Department of Ultrasonography, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- * Correspondence: Yang Hu, Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China (e-mail: )
| | - Yibo Zhou
- Department of Ultrasonography, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Petros PEP. Late-occurring pain/other dysfunctions in midurethral sling class actions are likely caused by uterosacral ligament weakness, not implant or surgeon. Neurourol Urodyn 2022; 41:1207-1215. [PMID: 35416320 PMCID: PMC9542506 DOI: 10.1002/nau.24925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/18/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022]
Abstract
Background Large sums of money have been awarded against manufacturers of midurethral slings (MUS) because of complaints of pain and other complications, even though pelvic pain is rarely seen at the 6–12 weeks review. Hypothesis and Aims Pain/other posterior fornix symptoms (urge, frequency, nocturia, and abnormal emptying) may appear weeks or months after MUS surgery due to dislocation of already weakened uterosacral ligaments (USL), a consequence of diversion of pelvic forces from pubourethral ligaments strengthened by the sling. Methods Review for prevalence, pathogenic pathway from damaged USLs to pain, OAB, emptying, and other late complications by reference to data from functional anatomy imaging, mechanical support of USLs (speculum test), and post‐USL surgical repair. Results Pelvic pain and other pelvic symptoms frequently co‐exist pre‐operatively with SUI, but are not volunteered because patients complain of one main pelvic symptom, others being “under the surface” (Pescatori Iceberg). Late de novo occurrence of symptom complications beyond perioperative MUS surgery may occur: pain (5.7%), retention (5.4%), UTI (9.3%), and OAB (10.2%). Xray/ultrasound evidence of pelvic forces acting on USLs support the hypothesis of diversion of forces. Improvement of pain and urgency by the “speculum test” indicates USL causation, as do cure of pain and other pelvic symptoms by USL slings. Conclusions Late‐occurring PFS symptoms are the fault of neither implant, nor surgeon, but more likely consequences of pelvic forces acting on USLs already weakened by childbirth/age. Bladder/bowel/pain symptoms need to be sought out preoperatively and discussed before MUS surgery. Brief Summary Late MUS complications, OAB, pain, retention subject to class actions, may be caused by uterosacral dislocation from pre‐existing structural weakness, not surgeon or device.
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Affiliation(s)
- Peter E P Petros
- School of Mechanical and Mathematical Engineering, University of Western Australia, Perth, Australia
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10
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Shebl SE. Two-year outcomes of surgeon-tailored trans obturator tape for female stress urinary incontinence: a randomized, comparative, trial with traditional trans obturator tape. BMC Urol 2021; 21:155. [PMID: 34772395 PMCID: PMC8590356 DOI: 10.1186/s12894-021-00922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Previously, we presented the short-term outcomes of surgeon-tailored mesh in patients with SUI undergoing TOT. In this report, we aim to highlight the two-year outcomes of surgeon tailored mesh in terms of subjective and objective cure rates, as well as late complications. Methods We performed a randomized, open-label comparative trial that recruited women with SUI who were scheduled to undergo TOT. Eligible patients were randomly allocated in a 1:1 ratio to receive traditional TOT mesh or surgeon-tailored polyethylene mesh. All patients were followed up for two years. Results At the end of the follow-up, there were 13 women in the traditional TOT mesh group and 14 patients in the surgeon-tailored polyethylene mesh group. Concerning the primary outcome of the present study, the cure rate was 100% in the surgeon-tailored polyethylene mesh (n = 14) and 92.9% in the traditional TOT mesh group (p = 0.39). One woman reported improved symptoms in the traditional TOT mesh group. There were no reported failures in both groups. Concerning safety, the incidence of de novo urgency was 0% in the surgeon-tailored polyethylene mesh group, compared to 7.1% in the traditional TOT mesh group (p = 0.34). None of the women in both groups reported mesh erosions, dyspareunia, or need for reoperation. Conclusion Surgeon-tailored mesh for patients undergoing TOT is a cost-effective technique, which has comparable long-term outcomes, in terms of cure rate and complications, to the traditional costly meshes. Larger multicentre studies should confirm our results.
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Affiliation(s)
- Salah E Shebl
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
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Lin YH, Lee CK, Chang SD, Chien PC, Hsu YY, Tseng LH. Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26257. [PMID: 34128853 PMCID: PMC8213295 DOI: 10.1097/md.0000000000026257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure. METHODS A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications. RESULTS A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported. CONCLUSIONS Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.
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Affiliation(s)
- Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Cheng-Kai Lee
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Shuenn-Dyh Chang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Pei-Chun Chien
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Yu-Ying Hsu
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Ling-Hong Tseng
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
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Liang CC, Shaw SWS, Chou HH, Huang YH, Lee TH. Amniotic Fluid Stem Cells Improve Rat Bladder Dysfunction After Pelvic Nerve Transection. Cell Transplant 2021; 29:963689720909387. [PMID: 32452747 PMCID: PMC7444231 DOI: 10.1177/0963689720909387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The effects of human amniotic fluid stem cells (hAFSCs) transplantation on bladder dysfunction after pelvic nerve transection (PNT) remain to be clarified. Five groups of female Sprague-Dawley rats were studied including sham operation, unilateral PNT alone or plus hAFSCs transplantation, and bilateral PNT alone or plus hAFSCs transplantation. hAFSCs were injected at the site of PNT. Cystometries, neurofilament density within bladder nerves, and the expressions of bladder protein gene-product 9.5 (PGP9.5), growth-associated protein 43 (GAP-43), nerve growth factor (NGF), p75 (NGF receptor), CXCL12, CCL7, and enkephalin were studied. Compared to sham-operation group, bladder weight increased and neurofilament density decreased at 10 and 28 days after unilateral and bilateral PNT, but all improved after hAFSCs transplantation. Unilateral PNT could increase bladder capacity, residual volume, and number of nonvoiding contractions but decrease peak voiding pressure and leak point pressure. Bilateral PNT caused overflow incontinence and increased the number of nonvoiding contractions. These cystometric parameters improved after hAFSCs transplantation. After PNT, bladder PGP9.5 mRNA and immunoreactivities decreased at 10 and 28 days, GAP-43 mRNA and immunoreactivities increased at 10 days and decreased at 28 days, both NGF and p75 mRNAs and immunoreactivities increased at 10 and/or 28 days, and enkephalin immunoreactivities decreased at 10 and 28 days, but these were all improved after hAFSCs transplantation. Our results showed that bladder dysfunction induced by PNT could be improved by hAFSCs transplantation, and PGP9.5, GAP-43, and neurotrophins could be involved in the mechanisms of nerve regeneration after hAFSCs transplantation.
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Affiliation(s)
- Ching-Chung Liang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan.,College of Medicine, Chang Gung University, Taoyuan
| | - Sheng-Wen Steven Shaw
- College of Medicine, Chang Gung University, Taoyuan.,Division of Obstetrics, Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei.,Prenatal Cell and Gene Therapy Group, Institute for Women's Health, University College London, London, UK
| | - Hung-Hsueh Chou
- College of Medicine, Chang Gung University, Taoyuan.,Gynecologic Oncology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan
| | - Yung-Hsin Huang
- Female Urology Section, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan.,Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
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13
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Peyronnet B, Greenwell T, Gray G, Khavari R, Thiruchelvam N, Capon G, Ockrim J, Lopez-Fando L, Gilleran J, Fournier G, Van Koeveringe GA, Van Der Aa F. Current Use of the Artificial Urinary Sphincter in Adult Females. Curr Urol Rep 2020; 21:53. [PMID: 33098485 DOI: 10.1007/s11934-020-01001-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. RECENT FINDINGS While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50 years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France. .,Service d'Urologie, Hopital Pontchaillou, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Gary Gray
- Department of Urology, University of Alberta, Edmonton, Canada
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| | - Luis Lopez-Fando
- Department of Urology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA
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Short-, mid-, and long-term incontinence outcomes in women undergoing mid-urethral sling procedures: a retrospective cohort study. Int Urogynecol J 2020; 32:609-614. [PMID: 32564122 DOI: 10.1007/s00192-020-04393-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The primary aim was to compare subjective treatment success among women in short-, mid-, and long-term follow-up after mid-urethral sling (MUS). Symptom severity, condition-specific quality of life (QOL), and patient satisfaction were also examined. METHODS Women undergoing a primary MUS between 2001 and 2010 were identified by CPT code. Eligible subjects were mailed the Urogenital Distress Inventory (UDI-6), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I), and Patient Satisfaction Questionnaire (PSQ). Follow-up intervals were short term (≤ 36 months), mid term (37-70 months), and long term (119-200 months). The primary outcome of treatment success was defined as responses of "not at all" or "somewhat" to both stress urinary incontinence (SUI) subscales on the UDI-6. RESULTS Of 896 respondents, 361 were assessed in the short-term (23.3 ± 7.2 months), 251 in the mid-term (49.8 ± 9.1 months), and 284 in the long-term group (147.9 ± 20.6 months). Treatment success was 75.4% in the short-, 62.3% in the mid-, and 67.0% in the long-term groups (p < 0.01). Logistic regression showed women with mid- and long-term follow-up were nearly half as likely as their short-term counterparts to report treatment success (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.36, 0.74). UDI-6 and PFIQ-7 scores differed significantly among the short-, mid- and long-term groups (p < 0.01). Patient satisfaction was similar, 83.3% in the short-, 76.6% in the mid-, and 78.2% in the long-term follow-up (p = 0.31). CONCLUSION Women with short-term follow-up had the highest subjective treatment success rates; mid- and long-term follow-up was lower, but sustained after 3 years. Symptom severity and impact on QOL were lowest in the short-term group. However, high satisfaction was noted across all groups.
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15
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D'alessandro G, Leone M, Antolini J, Ferrero S, Sala P, Melloni G, Fasolis G, Gustavino C. Three-year follow-up in patients with urinary stress incontinence treated with Altis® single-incision sling. MINERVA GINECOLOGICA 2020; 72:12-18. [PMID: 32153158 DOI: 10.23736/s0026-4784.20.04496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of the study is to report three years follow-up of single incision slings for the treatment of stress urinary incontinence (SUI). The main outcomes are to evaluate the efficacy of the device and to assess safety, adverse events, quality of life, demographic features of treated women and prognostic factors for SUI. METHODS We performed a retrospective, double-center, single-arm study. Data were collected by medical records and a telephone interview 3 years after the implant of the mini-sling. Complication rate, subjective efficacy and degree of satisfaction were investigated. RESULTS Fifty-four patients were treated between March 2015 and March 2017, of which 47 answered the survey. Forty-one of 47 procedures (87.2%) were considered effective. Among more relevant complications, there was one case of extrusion of mesh and three cases of new onset of urinary disfunction, of which two cases of urgency urinary incontinence (UUI) and one case of de-novo SUI. Most complications were solved within few days after the procedure. Concerning the subjective impression of improvement, investigated by using the Patient Global Impression of Improvement (PGI-I) questionnaires, 41 patients reported subjective satisfaction, three reported no change in quality of life and three patients had worsening of symptoms. CONCLUSIONS The procedure was safe and effective for the treatment of SUI but more data are needed to confirm our preliminary results.
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Affiliation(s)
- Gloria D'alessandro
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy - .,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy -
| | - Maurizio Leone
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy
| | - Jacopo Antolini
- Department of Urology, San Lazzaro Hospital, ASL-CN2, Alba, Cuneo, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Paolo Sala
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy
| | - Guglielmo Melloni
- Department of Urology, San Lazzaro Hospital, ASL-CN2, Alba, Cuneo, Italy
| | - Giuseppe Fasolis
- Department of Urology, San Lazzaro Hospital, ASL-CN2, Alba, Cuneo, Italy
| | - Claudio Gustavino
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy
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Nikolopoulos KI, Chrysanthopoulou E, Pergialiotis V, Korrou LM, Perrea DN, Dimitroulis D, Doumouchtsis SK. An animal experimental study on pubourethral ligament restoration with platelet rich plasma for the treatment of stress urinary incontinence. Cent European J Urol 2019; 72:134-141. [PMID: 31482019 PMCID: PMC6715089 DOI: 10.5173/ceju.2019.1896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/08/2019] [Accepted: 05/31/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Minimally invasive methods for injured ligament and tendon restoration have been developed and gained popularity in recent years. Injury and relaxation of the pubourethral ligament (PUL) can lead to stress urinary incontinence (SUI). The aim of this study was to investigate the impact of injecting platelet rich plasma (PRP) into the PUL following its surgical transection resulting in SUI, confirmed by leak point pressure (LPP) measurements pre- and post-intervention in an experimental animal model. Material and methods Twenty female adult Sprague-Dawley rats were assigned in 2 groups: 1) treatment group with transection of the PUL and application of PRP at the time of transection and at one month follow-up and 2) a control group, with transection of the PUL only. Leak point pressures (LPPs) were measured prior to transection, immediately following the transection and at 1 and 2 months in both groups. Results The median LPPs for the control group were: LPP – preT: 35.6 (29.8–44.8) cmH2O, LPP – postT: 14.6 (5.8–19.0) cmH2O, LPP – 1 month: 27.3 (19.2–33.8) cmH2O, LPP – 2 months: 29.0 (27.0–34.0) cmH2O, whereas for the PRP group were: LPP-preT: 40.5 (33.2–46.3) cmH2O, LPP – postT: 15.7 (3.0–24.0) cmH2O, LPP – 1month: 31.6 (24.8–37.4) cmH2O, LPP – 2 months: 36.8 (32.5–45.4) cmH2O. PRP injections on transected PULs significantly increased LPPs at one month follow-up [31.6 cmH2O vs. 27.3 cmH2O, p = .043]. This effect was confirmed at two months [36.8 cmH2O vs. 29.0 cmH2O, p <.001]. Conclusions Injection of PRP into transected PULs significantly improved LPPs at one and two months' follow-up. However, further experimental and clinical research is needed to evaluate the safety and efficacy of this treatment, in clinical practice.
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Affiliation(s)
- Kostis I Nikolopoulos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece.,Epsom and St Helier University Hospitals NHS Trust, Urogynaecology, Obstetrics and Gynaecology, London, United Kingdom
| | - Eleftheria Chrysanthopoulou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece.,King's College Hospital, Department of Obstetrics and Gynaecology, London, United Kingdom
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece
| | - Laskarina Maria Korrou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece
| | - Despina N Perrea
- Epsom and St Helier University Hospitals NHS Trust, Urogynaecology, Obstetrics and Gynaecology, London, United Kingdom
| | - Dimitrios Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece
| | - Stergios K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece.,Epsom and St Helier University Hospitals NHS Trust, Urogynaecology, Obstetrics and Gynaecology, London, United Kingdom.,St. George's University of London, London, United Kingdom
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17
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Shin JH, Choo MS. De novo or resolved urgency and urgency urinary incontinence after midurethral sling operations: How can we properly counsel our patients? Investig Clin Urol 2019; 60:373-379. [PMID: 31501800 PMCID: PMC6722402 DOI: 10.4111/icu.2019.60.5.373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate de novo and resolved urgency and urgency urinary incontinence (UUI) after midurethral sling operations in patients with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Materials and Methods Patients who underwent midurethral sling operations because of SUI and MUI between January 2012 and December 2016 were reviewed. Patients were divided into three groups (pure SUI, SUI with urgency, and MUI). Patients with MUI were subcategorized as SUI predominant, equivalent, and UUI predominant. Postoperative de novo, persistent or disappearance of urgency or UUI were compared. Results A total of 334 patients were included: 76 with pure SUI, 78 with SUI with urgency, and 180 with MUI. In the MUI group, 138 patients were SUI predominant, 12 patients were equivalent, and 30 patients were UUI predominant. De novo urgency developed in 5 patients (6.6%) in the pure SUI group. In the SUI with urgency group, 51 patients (65.4%) became urgency-free, and 3 (3.8%) developed de novo UUI. UUI resolved in 135 patients (75.0%): 110 (79.7%) in the SUI-predominant group, 9 (75.0%) in the equivalent group, and 16 (53.3%) in the UUI-predominant group. The patients' preoperative perception of predominant UUI was the predictive factor for persistent UUI in the multivariate analysis (hazard ratio, 5.722; p=0.001). Conclusions De novo urgency and UUI developed in a relatively small number of patients after a midurethral sling operation. The resolution rate of UUI was significantly low in patients who had previous pelvic surgery or who preoperatively perceived UUI as a more bothersome symptom.
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Affiliation(s)
- Jung Hyun Shin
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Güler Y, Erbin A, Üçpınar B. Transobturator tape material detected in the bladder neck: a case report. J Med Case Rep 2019; 13:119. [PMID: 31036070 PMCID: PMC6489214 DOI: 10.1186/s13256-019-2059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Stress urinary incontinence surgeries (transobturator tape and tension-free vaginal tape) are safely performed with success rates over 90%. The transobturator tape procedure attracted more attention due to the lack of major complications, such as intraabdominal organ and vascular injuries, related to the tension-free vaginal tape procedure. Although there are no major or mortality-related complications, more lower urinary complaints, especially vaginal erosion, are reported in transobturator tape surgery. Here we present a rare complication of transobturator tape surgery: the accidental placement of mesh material in the bladder neck. With this case report, we aimed to discuss the diagnosis and management of misplaced transobturator tape material. CASE PRESENTATION A 38-year-old Caucasian woman who had stress urinary incontinence that had persisted for 6 years underwent transobturator tape surgery in a different clinic 2 years ago. Subsequently, she presented to our clinic with lower urinary tract complaints such as incontinence and dysuria. A physical examination was unremarkable besides total incontinence. A diagnostic cystoscopy was performed and sling material that crossed her bladder neck from 3 o'clock to 10 o'clock was identified. The misplaced transobturator tape material was cut endoscopically with an internal urethrotomy knife. Afterwards, a midurethral incision was made and mesh parts were removed bilaterally. After successful removal of the mesh material, a new transobturator tape was placed. CONCLUSIONS Even though transobturator tape surgery is a safe and effective procedure for stress urinary incontinence, certain complications can be encountered. Misplacement of the mesh material through the bladder neck is a rare complication and can be managed by successfully removing the mesh material and appropriately placing new transobturator tape material.
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Affiliation(s)
- Yavuz Güler
- Department of Urology, Safa Hospital, Istanbul, TR, Turkey.
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Burak Üçpınar
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
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19
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Itkonen Freitas AM, Rahkola-Soisalo P, Mikkola TS, Mentula M. Current treatments for female primary stress urinary incontinence. Climacteric 2019; 22:263-269. [DOI: 10.1080/13697137.2019.1568404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A.-M. Itkonen Freitas
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - P. Rahkola-Soisalo
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - T. S. Mikkola
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - M. Mentula
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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21
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Cashman S, Biers S, Greenwell T, Harding C, Morley R, Cooper D, Fowler S, Thiruchelvam N. Results of the British Association of Urological Surgeons female stress urinary incontinence procedures outcomes audit 2014-2017. BJU Int 2018; 123:149-159. [PMID: 30222915 DOI: 10.1111/bju.14541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyse the results of the stress urinary incontinence (SUI) audit conducted by the British Association of Urological Surgeons (BAUS), and to present UK urologists' contemporary management of SUI. PATIENTS AND METHODS The BAUS audit tool is an online resource, to which all UK urologists performing procedures for SUI are invited to submit data. The data entries for procedures performed during 2014-2016 were collated and analysed. RESULTS Over the 3-year period analysed, 2917 procedures were reported by 109 surgeons, with a median of 20 procedures reported per surgeon. A total of 2 366 procedures (81.1%) were recorded as a primary surgery, with 548 procedures (18.8%) performed for recurrent SUI. Within the time period analysed, changes were noted in the frequency of all procedures performed, with a trend towards a reduction in the use of synthetic mid-urethral tapes, and a commensurate increase in the use of urethral bulking agents and autologous fascial slings. A total of 107 (3.9% of patients) peri-operative complications were recorded, with no association identified with patient age, BMI or surgeon volume. Follow-up data were available on 1832 patients (62.8%) at a median of 100 days postoperatively. Reduced pad use was reported in 1311 of patients (84.5%) with follow-up data available and 86.3% reported a pad use of one or less per day. In all, 375 patients (85%) reported being satisfied or very satisfied with the outcome of their procedure at follow-up, although data entry for this domain was poor. De novo overactive bladder (OAB) symptoms were reported by 15.2% of patients (263/1727), and this was the most commonly reported postoperative complication. For those reporting pre-existing OAB prior to their SUI surgery, 28.7% (307/1069) of patients reported they got better after their procedure, whilst 61.9% (662/1069) of patients reported no change and 9.4% of patients (100/1 069) got worse. CONCLUSIONS This review identified that, despite urological surgeons undertaking a relatively low volume of procedures per year, SUI surgery by UK urologists is associated with excellent short-term surgeon- and patient-reported outcomes and low numbers of low grade complications. Complications do not appear to be associated with surgeon volume, nor do they appear higher in those undergoing mesh surgery. Shortfalls in data collection have been identified, and a longer follow-up period is required to comment adequately on long-term complications, such as chronic pain and tape extrusion/erosion rates.
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Affiliation(s)
- Sophia Cashman
- Luton and Dunstable Hospital NHS Foundation Trust, London, UK
| | - Suzanne Biers
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Chris Harding
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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22
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Zhang Y, Song X, Zhang Z, Mao M, Ai F, Kang J, Zhu L. Tension-free vaginal tape-obturator for the treatment of stress urinary incontinence: a 12-year prospective follow-up. BJU Int 2018; 123:E57-E62. [PMID: 30248230 DOI: 10.1111/bju.14555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term safety and effectiveness of inside-out transobturator tape (tension-free vaginal tape-obturator, TVT-O) for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS Between August 2004 and August 2006, 87 consecutive patients with SUI who underwent TVT-O were enrolled in this prospective cohort study. Patients with mixed UI, or pelvic organ prolapse requiring surgery, were excluded. Data relating to long-term postoperative complications, subjective satisfaction rate (Patient Global Impression of Improvement), objective cure rate (stress test), quality of life (QoL), and sexual function, were collected during follow-up. The Incontinence Impact Questionnaire (IIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were used to assess QoL and sexual function, respectively. Statistical analyses were performed using paired-sample t-tests. RESULTS At the 12-year follow-up, 73 patients (84%) were available for evaluation. Overall, the long-term complication rate was 45.2%. De novo overactive bladder was observed in 12.3% of patients. None of the patients reported severe voiding dysfunction that required treatment by tape removal or catheterisation. However, 16 patients (16/73, 21.9%) had voiding changes compared with their preoperative status. Persistent groin pain was reported in 1.4% of the patients, and tape exposure occurred in 5.5%. The subjective satisfaction rate and objective cure rate were 80.8% and 82.2%, respectively. Compared with preoperative scores, the IIQ-7 score decreased significantly (P < 0.05), whilst there was no significant difference in the PISQ-12 score (P = 0.893). CONCLUSIONS This 12-year follow-up study showed that TVT-O is a highly effective procedure for the treatment of SUI. The long-term complication rate appears to be slightly high, which should raise concern.
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Affiliation(s)
- Ye Zhang
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xiaochen Song
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Zhibo Zhang
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Meng Mao
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Ai
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
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23
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Song Y, Wang XJ, Chen YS, Hua KQ. Management of Urinary Incontinence before and after Total Pelvic Reconstruction for Advanced Pelvic Organ Prolapse with and without Incontinence. Chin Med J (Engl) 2018; 131:553-558. [PMID: 29483389 PMCID: PMC5850671 DOI: 10.4103/0366-6999.226057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The effectiveness of an anti-incontinence procedure concomitant with prolapse reconstruction for pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for pelvic reconstructive surgery and evaluate the management of POP associated with UI. Methods: A total of 329 patients who underwent total pelvic reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift reconstruction]: n = 190 and Group B [modified total pelvic reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student's t-tests were used for two independent samples. Results: A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total pelvic reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ2= 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ2= 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ2= 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of reconstructions (P > 0.05). Conclusions: No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions.
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Affiliation(s)
- Yu Song
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Xiao-Juan Wang
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Yi-Song Chen
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Ke-Qin Hua
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases; Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
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24
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Capobianco G, Madonia M, Morelli S, Dessole F, De Vita D, Cherchi PL, Dessole S. Management of female stress urinary incontinence: A care pathway and update. Maturitas 2018; 109:32-38. [DOI: 10.1016/j.maturitas.2017.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 01/12/2023]
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25
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Braga A, Caccia G, Sorice P, Cantaluppi S, Coluccia AC, Di Dedda MC, Regusci L, Ghezzi F, Uccella S, Serati M. Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 17-year follow-up. BJU Int 2018; 122:113-117. [PMID: 29468798 DOI: 10.1111/bju.14136] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology; EOC - Beata Vergine Hospital; Mendrisio Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology; EOC - Beata Vergine Hospital; Mendrisio Switzerland
| | - Paola Sorice
- Department of Obstetrics and Gynecology; G. Fornaroli Hospital; Magenta Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology; University of Insubria; Varese Italy
| | | | | | - Luca Regusci
- Department of Obstetrics and Gynecology; EOC - Beata Vergine Hospital; Mendrisio Switzerland
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology; University of Insubria; Varese Italy
| | - Stefano Uccella
- Department of Woman and Child Health; Fondazione Policlinico Gemelli; Rome Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology; University of Insubria; Varese Italy
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Gomes CM, Carvalho FL, Bellucci CHS, Hemerly TS, Baracat F, de Bessa J, Srougi M, Bruschini H. Update on complications of synthetic suburethral slings. Int Braz J Urol 2017; 43:822-834. [PMID: 28266818 PMCID: PMC5678512 DOI: 10.1590/s1677-5538.ibju.2016.0250] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/05/2016] [Indexed: 01/10/2023] Open
Abstract
Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
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Affiliation(s)
- Cristiano Mendes Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | | | | | - Thiago Souto Hemerly
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fábio Baracat
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Jose de Bessa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Homero Bruschini
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Prospective and randomized clinical trial comparing transobturator versus retropubic sling in terms of efficacy and safety. Int Urogynecol J 2017; 29:29-35. [DOI: 10.1007/s00192-017-3495-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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The Efficiency and Safety of Tension-Free Vaginal Tape (TVT) Abbrevo Procedure Versus TVT Exact in the Normal Weight and Overweight Patients Affected by Stress Urinary Incontinence. Urology 2017; 110:63-69. [PMID: 28822841 DOI: 10.1016/j.urology.2017.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/03/2017] [Accepted: 06/21/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the efficacy between 2 different slings in normal weight and overweight women. METHODS Of 426 women, 220 (119 normal weight and 101 overweight) accepted the tension-free vaginal tape Abbrevo (TVT-A) and 206 (114 normal weight and 92 overweight) accepted the TVT Exact (TVT-E) procedure. Data collected contained the subjective efficiency, objective efficiency International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Incontinence Quality of Life Questionnaire (I-QOL), Pelvic Floor Impact Questionnaire-Short Form (PFIQ-7), Urogenital Distress Inventory-Short Form (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-Short Form (PISQ)-12 at 36 months after surgery. RESULTS In the normal weight patients, the subjectively and objectively cured rates were all high in both TVT-A and TVE-E (94.12% and 95.61% in objective result; 92.44% and 94.74% in subjective result). In addition, the score of I-QOL, PFIQ-7, and UDI-6 have significantly changed (P <.00001 in each one). In the overweight patients, the subjective and objective efficiency were better in TVT-E than TVT-A. Moreover, the score of I-QOL, PFIQ-7, and UDI-6 of overweight women have significantly changed only in the TVT-E (P <.00001 in each one), whereas both procedures have no effect on the score of PISQ-12 (P = .063 and P = .180 for TVT-A and TVT-E, respectively). CONCLUSION The TVT-E might be a better choice for the overweight patient than TVT-A.
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Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence. Eur Urol 2017; 72:567-591. [PMID: 28479203 DOI: 10.1016/j.eururo.2017.04.026] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/19/2017] [Indexed: 11/23/2022]
Abstract
CONTEXT Retropubic (RP-TVT) and transobturator miurethral (TO-TVT) midurethral sling (MUS) are popular surgical treatments for female stress urinary incontinence. The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomised controlled trials (RCTs) have been published in the last years OBJECTIVE: To evaluate the efficacy and safety of MUS compared with other surgical treatments for female stress urinary incontinence. EVIDENCE ACQUISITION A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses. EVIDENCE SYNTHESIS Twenty-eight RCTs were identified. In total, the meta-analyses included 15 855 patients. Patients receiving MUS had significantly higher overall (odds ratio [OR]: 0.59, p=0.0003) and objective (OR: 0.51, p=0.001) cure rates than those receiving Burch colposuspension. Patients undergoing MUS and pubovaginal slings had similar cure rates. Patients treated with RT-TVT had higher subjective (OR: 0.83, p=0.03) and objective (OR: 0.82, p=0.01) cure rates than those receiving TO-TVT. However, the latter had a lower risk of intraoperative bladder or vaginal perforation (OR: 2.4, p=0.0002), pelvic haematoma (OR: 2.61, p=0.002), urinary tract infections (OR: 1.31, p=0.04) and voiding lower urinary tract symptoms (OR: 1.66, p=0.002). Sensitivity analyses limited to RCTs with follow-up durations >60 mo demonstrated similar outcomes for RP-TVT and TO-TVT. No significant differences in efficacy were identified comparing inside-to-out and outside-to-in TO-TVT but vaginal perforations were less common with the former (OR: 0.21, p=0.0002). CONCLUSIONS The present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding lower urinary tract symptoms. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT. PATIENT SUMMARY Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra- and postoperative complications.
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Serati M, Braga A, Athanasiou S, Tommaselli GA, Caccia G, Torella M, Ghezzi F, Salvatore S. Tension-free Vaginal Tape–Obturator for Treatment of Pure Urodynamic Stress Urinary Incontinence: Efficacy and Adverse Effects at 10-year Follow-up. Eur Urol 2017; 71:674-679. [PMID: 27597239 DOI: 10.1016/j.eururo.2016.08.054] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
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Leone Roberti Maggiore U, Finazzi Agrò E, Soligo M, Li Marzi V, Digesu A, Serati M. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2017; 28:1119-1130. [PMID: 28213797 DOI: 10.1007/s00192-017-3275-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
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Liang CC, Hsieh WC, Huang L. Outcome of coexistent overactive bladder symptoms in women with urodynamic urinary incontinence following anti-incontinence surgery. Int Urogynecol J 2016; 28:605-611. [DOI: 10.1007/s00192-016-3153-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/01/2016] [Indexed: 11/29/2022]
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Carlson NS. Current Resources for Evidence-Based Practice, September/October 2016. J Obstet Gynecol Neonatal Nurs 2016; 45:e57-66. [DOI: 10.1016/j.jogn.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Parden AM, Tang Y, Szychowski J, Richter HE. Characterization of Lower Urinary Tract Symptoms Before and After Midurethral Sling Revision. J Minim Invasive Gynecol 2016; 23:979-85. [DOI: 10.1016/j.jmig.2016.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 12/22/2022]
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Luz R, Pereira I, Henriques A, Ribeirinho AL, Valentim-Lourenço A. King's Health Questionnaire to assess subjective outcomes after surgical treatment for urinary incontinence: can it be useful? Int Urogynecol J 2016; 28:139-145. [PMID: 27423456 DOI: 10.1007/s00192-016-3089-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Midurethral slings (MUS) are the mainstay of treatment for stress urinary incontinence, but the definition of success varies widely amongst studies. The King's Health Questionnaire (KHQ) was designed to evaluate the impact of urinary incontinence on the quality of life. We hypothesised that the KHQ could be useful for postoperative quantitative assessment of subjective outcomes. MATERIALS AND METHODS This is a retrospective analysis of 204 patients who underwent incontinence surgery with transobturator MUS between 2004 and 2013. Follow-up was planned at 6, 12 and 24 months and success was evaluated using the cough stress test (objective cure) and the KHQ global score (subjective outcomes). Statistical analysis included receiver operating characteristic (ROC) curves to calculate a cut-off value for the KHQ global score to define subjective cure. The minimal clinically important difference was calculated with a distribution-based method (effect size) to estimate subjective improvement. RESULTS Objective cure rates were 97 % and 95 % at 6 and 24 months respectively. ROC curves established the cut-off score at ≤ 31 for subjective cure, with sensitivity of 63-100 % and specificity of 82-88 %. Subjective cure rates were 80 % and 85 % at 6 and 24 months respectively. The minimal clinically important difference was set at 10 and an improvement of ≥ 10 points was defined as subjective improvement. Rates varied between 10 and 13 %. CONCLUSIONS This study showed the value of the KHQ as an evaluation tool after UI surgery and determined clinically relevant threshold scores to define subjective outcomes.
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Affiliation(s)
- Rita Luz
- Department of Obstetrics and Gynecology, Centro Hospitalar de Setúbal, Setubal, Portugal. .,, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal.
| | - Inês Pereira
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - Alexandra Henriques
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana Luísa Ribeirinho
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
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Kerbaj J, Aubry C, Prost C, Brouqui P. Thigh abscess and necrotizing fasciitis following an inside-out transobturator tape intervention: a case report. J Med Case Rep 2016; 10:146. [PMID: 27256334 PMCID: PMC4890333 DOI: 10.1186/s13256-016-0942-3] [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: 12/30/2015] [Accepted: 05/10/2016] [Indexed: 01/04/2023] Open
Abstract
Background Tension-free vaginal transobturator tapes are used worldwide in the treatment of urinary incontinence in women. Very few severe complications have been described following this procedure, with no standard treatment yet established. Case presentation We present the case of a 36-year-old French white woman with no remarkable medical history, presenting with an abscess and necrotizing fasciitis 48 hours after an inside-out tension-free transobturator procedure. Samples were collected by guided puncture from the abscess, retrieving Staphylococcus aureus and Citrobacter koseri. Conclusions Severe complications following this procedure are rare, although it can have the potential for significant morbidity and even mortality, which is worth highlighting. We recommend early surgical treatment in combination with broad-spectrum antibiotics and coverage for Staphylococcus aureus, which may be a causative agent. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-0942-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jad Kerbaj
- Maladies Infectieuses et Tropicales, CHU Nord, AP-HM, Pôle des Maladies Infectieuses et Tropicales, Marseille, France.,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France
| | - Camille Aubry
- Maladies Infectieuses et Tropicales, CHU Nord, AP-HM, Pôle des Maladies Infectieuses et Tropicales, Marseille, France.,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Caroline Prost
- Service d'imagerie Médicale, CHU Nord, AP-HM, Marseille, France
| | - Philippe Brouqui
- Maladies Infectieuses et Tropicales, CHU Nord, AP-HM, Pôle des Maladies Infectieuses et Tropicales, Marseille, France. .,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France. .,Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.
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Nikolopoulos KI, Pergialiotis V, Perrea D, Doumouchtsis SK. Restoration of the pubourethral ligament with platelet rich plasma for the treatment of stress urinary incontinence. Med Hypotheses 2016; 90:29-31. [PMID: 27063081 DOI: 10.1016/j.mehy.2016.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/05/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Abstract
Stress urinary incontinence (SUI) is a major health problem, which affects nearly 20% of adult women and has a detrimental impact on their daily activities and quality of life. Several surgical techniques have been proposed for the treatment of SUI including the Burch colposuspension, retropubic mid-urethral slings (TVT), trans-obturator tapes (TOT), trans-obturator tapes inside out (TVT-O), bladder neck injections and the insertion of an artificial urethral sphincter. All of these treatments aim to either restore the urethral support, which is naturally preserved by the pubourethral ligament (PUL) or to increase the urethral resistance at rest. Most surgical techniques are associated with a variety of intraoperative and postoperative complications. Platelet rich plasma (PRP) is extremely rich in growth factors and cytokines, which regulate tissue reconstruction and has been studied extensively among trauma patients and trauma experimental models. To date, however, there is no evidence to support or oppose its use in women who suffer from SUI due to PUL damage. PRP is an easily produced and relatively inexpensive biologic material. It is produced directly from the patient's blood and is, thus, superior to synthetic materials in terms of potential adverse effects such as from foreign body reaction. In the present article we summarize the existing evidence in the field, which supports the conduct of animal experimental and clinical studies to elucidate the potential role of PRP in treating SUI.
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Affiliation(s)
- Kostis I Nikolopoulos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece; Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece
| | - Despina Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, University of Athens, Greece
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust/St George's University of London, United Kingdom
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Thubert T, Canel V, Vinchant M, Wigniolle I, Fernandez H, Deffieux X. Bladder injury and success rates following retropubic mid-urethral sling: TVT EXACT™ vs. TVT™. Eur J Obstet Gynecol Reprod Biol 2016; 198:78-83. [PMID: 26802254 DOI: 10.1016/j.ejogrb.2016.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT). STUDY DESIGN This retrospective study compared TVT-E (n=49) and TVT (n=49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc.) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs. RESULTS Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively (p=1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8.0 vs. 15.9, p=0.01). The first post-void residual was increased in the TVT-E group (153.9 vs. 78.9mL, p=0.045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p=0.02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p=0.16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p=1). CONCLUSION The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up.
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Affiliation(s)
- Thibault Thubert
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France
| | - Virginie Canel
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France
| | - Marie Vinchant
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France
| | - Ingrid Wigniolle
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France
| | - Hervé Fernandez
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Bicêtre, Service de Gynécologie Obstétrique, Le Kremlin Bicetre F-94275, France
| | - Xavier Deffieux
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Clamart F-94000, France.
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Efficacy and safety of the trans-obturator TVT-Abbrevo device in normal weight compared to overweight patients affected by stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2015; 197:116-9. [PMID: 26722996 DOI: 10.1016/j.ejogrb.2015.11.014] [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: 10/03/2015] [Revised: 11/04/2015] [Accepted: 11/17/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate if TVT-Abbrevo has similar outcomes in normal weight and overweight patients. STUDY DESIGN Retrospective evaluation of 205 (105 normal weight women and 100 overweight women with BMI ≥ 25 kg/m(2)) undergone TVT-Abbrevo positioning with 12 month follow-up. Primary outcomes were objective cure rate (defined as no leakage during CST) and subjective cure rate ("very much improved"/"much improved" at PGI-I), secondary outcomes were intra-operative and post-operative complications. RESULTS Objective cure rates in the normal and overweight groups were 96.2% and 94%, respectively (p=.47). Subjective cure rates in the normal and overweight groups were 90.5% and 88%, respectively (p=.57). ICIQ-SF, I-QoL and PGI-S scores significantly improved in both groups with no differences between the two groups. No serious intra- or post-operative complications were observed. No differences were observed in pain VAS scores and number of analgesic vials administered. CONCLUSIONS TVT-Abbrevo seems to have similar efficacy and safety in normal weight and overweight women. More studies are needed to assess the efficacy of this device in frankly obese women and long-term outcomes.
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