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E Shebl S, Ali E, Ibrahim S. Single-incision needleless mini-sling technique for female stress urinary incontinence: A comparative study with standard transobturator inside-out technique. Arch Ital Urol Androl 2023:11342. [PMID: 37254935 DOI: 10.4081/aiua.2023.11342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/30/2023] [Indexed: 06/01/2023] Open
Abstract
To evaluate the safety and efficacy of surgeon-tailored polypropylene mesh (STM) through a needle-less single incision mini-slings (SIMS) vs. standard trans-obturator tape (TOT) in the treatment of female stress urinary incontinence (SUI). METHODS We conducted an open-label randomized controlled trial that included women with SUI. Eligible women were randomized in a 1:1 ratio to receive either standard TOT or SIMS techniques. All procedures were performed using a surgeon-tailored polypropylene mesh and monofilament tape. RESULTS A total of 60 women were included. The mean operative time was significantly longer in the standard TOT group. The mean bleeding rate was significantly higher in the standard TOT group (87.6 ± 10.6 cc) compared to the SIMS group (60.0 ± 8.1 cc). There was no urethral injury in both groups. Transient thigh pain occurs in 12 cases (40 %) of the standard TOT and no cases in the SIMS group (p < 0.001). After three months, there was no significant statistical difference between the result of the two groups as regard to cure or improvement rate. No failed cases were reported in both groups (p = 0.64). Likewise, there was no significant difference between the two groups regarding patients' satisfaction rate. CONCLUSIONS SIMS was not inferior to standard TOT. STM SIMS is a mini-invasive, relatively safe, reproducible, easy to perform in a short time, with excellent patient tolerability and minimal pain, allowing early return to work and economically effective surgical procedure for the treatment of female stress urinary incontinence.
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Affiliation(s)
- Salah E Shebl
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo.
| | - Eman Ali
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo.
| | - Sayeda Ibrahim
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo.
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Evaluation of the effectiveness of transobturator tape operation in the treatment of stress incontinence. JOURNAL OF CONTEMPORARY MEDICINE 2023. [DOI: 10.16899/jcm.1203481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background/Aims:: In this study, In this study, we aimed to assess the effectiveness of Transobturator Tape Operation in the treatment of Stress İncontinence
Methods: We retrospectively evaluated 454 patients who had TOT operations due to stress urinary incontinence between January 1, 2017, and December 31, 2020, at the İstanbul Kanuni Traning and Research Hospital. The basic clinical characteristics of the participants were recorded. The number of daily peds, values of Q-type test and urinary retention, and scores of urogenital disorder inventory-6 and impact of incontinence inquiry form at the clinical evaluation perioperatively and 6 months after the operation. Data analysis of the study was done with the SPSS version 24.0 package program. Kolmogorov-Smirnov test was used for normality analysis. Wilcoxon test was used for the comparisons of preop and postop data. It was considered statistically significant when the P value was below 0.05
Results: The study was conducted on 454 patients aged 26-83 years with a mean age of 50.3±10 years. The overall complication rate was 15.9. The rate of those who recovered six months after the operation was 89.6%. The number of daily peds, values of Q-tip test and urinary retention, and scores of questionnaires were significantly reduced after surgery (p=0.001).
Conclusions: The TOT operation can be preferred in treating stress incontinence with acceptable success and outcome. The scales of questionnaires successfully determine patient satisfaction with surgical efficacy for SUI.
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Even L, Tibi B, Bentellis I, Treacy PJ, Berrogain N, Bosset PO, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu JF, Hurel S, Klap J, Meyer F, Peyrat L, Thuillier C, Vidart A, Wagner L, Cornu JN. [Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology]. Prog Urol 2021; 31:1141-1166. [PMID: 34794867 DOI: 10.1016/j.purol.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. OBJECTIVES In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. RESULTS Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. CONCLUSION Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.
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Affiliation(s)
- L Even
- Cabinet d'urologie, espace santé 3 83500 La Seyne sur Mer, clinique du Cap d'Or, 83500 La Seyne sur mer, Polyclinique Les Fleurs, 83190 Ollioules, France
| | - B Tibi
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - I Bentellis
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - P J Treacy
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU Estaing, Clermont-Ferrand, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot Fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - S Hurel
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 91480 Quincy-sous-Sénart, France
| | - F Meyer
- Service d'urologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J N Cornu
- Service d'urologie, université de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Aygül C, Özyurt R, Şık BA, Kumbasar S. Evaluation of the efficacy of transobturator tape surgery in the treatment of stress urinary incontinence using urodynamics and questionnaires. Turk J Obstet Gynecol 2016; 13:172-177. [PMID: 28913117 PMCID: PMC5558288 DOI: 10.4274/tjod.46034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/06/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To measure the efficiency of transobturator tape (TOT) surgery using urodynamics and questionnaires in stress urinary incontinence. MATERIALS AND METHODS Ninety-two patients with stress and mixed urinary incontinency who underwent TOT surgery were selected for the study. We retrospectively examined the patients' urodynamics, ultrasonography, demographic characteristics, incontinency surveys, life quality scores [incontinence impact questionnaire, (IQ-7) and urinary distress inventory (UDI-6)], diagnostic findings, Q-type test, surgical records, and complications. Patients treatment adherence, life quality scores, and urodynamics were evaluated as per the findings and complications following discharge of the patients between 12 and 36 months. Patients with a surgical history as the result of incontinence were excluded from the study. RESULTS Prior to surgery, 57 (61%, 95) patients had stress urinary incontinence (SUI), and 35 (38%, 05) patients had mixed urinary incontinence (MUI). During surgery, 45 (48%, 91) patients underwent extra pelvic surgical intervention. The mean follow-up time was 22.17±7.55 months. Our subjective success rate was 91%, 3 and the objective success rate was 78%, 3. In the life quality evaluation, a statistically significant improvement was found between IIQ-7 and UDI-6 scores. Parity over 4 was an important failure reason. Two (2%, 17) patients developed vaginal erosion, 2 (2%, 17) of the patients developed temporary urine retention, and 1 (1%, 08) patient developed nova urge incontinence. CONCLUSION Our study demonstrates that TOT surgery provides high objective and subjective success and has a positive impact on life quality. The ease of application and lower complication rate makes TOT a valuable alternative for other treatment approaches in the surgical treatment of SUI.
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Affiliation(s)
- Cihan Aygül
- İstanbul Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ramazan Özyurt
- İstanbul Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bulat Aytek Şık
- İstanbul Aydın University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Serkan Kumbasar
- Sakarya Training and Research Hospital, Clinic of Obstetrics and Gynecology, Sakarya, Turkey
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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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Sohbati S, Salari Z, Eftekhari N. Comparison Between the Transobturator Tape Procedure and Anterior Colporrhaphy With the Kelly's Plication in the Treatment of Stress Urinary Incontinence: a Randomized Clinical Trial. Nephrourol Mon 2015; 7:e32046. [PMID: 26543834 PMCID: PMC4630418 DOI: 10.5812/numonthly.32046] [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: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022] Open
Abstract
Background Stress urinary incontinence in women is a common problem that impairs the quality of life in patients. The extraordinary number of procedures to treat stress urinary incontinence reflects a lack of consensus on an appropriate intervention for this problem. Objectives The current study aimed to compare the results of transobturator tape (TOT) procedure and anterior colporrhaphy with the Kelly’s Plication to treat women with stress urinary incontinence. Patients and Methods This randomized clinical trial was conducted on 60 patients with stress urinary incontinence referred to Afzalipour Hospital in Kerman, Iran. The patients were randomly divided into two surgery groups and were subsequently assessed regarding the outcomes of the procedures, incontinence symptoms and complications during the follow-up period. Results The cure rates at follow-up period of one month, six months and one year after surgery were 86.7%, 80% and 80% in the TOT group versus 80%, 70% and 66.7% in the anterior colporrhaphy with the Kelly’s Plication group, respectively. There were no significant differences between the two groups in the aforementioned follow-up periods (P = 0.68, P = 0.54 and P = 0.22, respectively). Conclusions The current results showed no significant differences between the outcomes of the two procedures at short-term follow-up. However, the results might have changed in the long term.
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Affiliation(s)
- Samira Sohbati
- Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Zohreh Salari
- Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, IR Iran
- Corresponding author: Zohreh Salari, Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, IR Iran. Tel: +98-9133431812, Fax: +98-3432457221, E-mail:
| | - Nahid Eftekhari
- Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, IR Iran
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Serey-Eiffel S, Coquet JB, Fournier G, Valeri A, Perrouin-Verbe MA. [Outpatient suburethral sling in women: Review of the literature]. Prog Urol 2015; 25:1204-12. [PMID: 26149176 DOI: 10.1016/j.purol.2015.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to assess efficacy, complication and feasibility of outpatient suburethral slings for stress urinary incontinence in women. MATERIAL AND METHODS A systematic review of the literature was done from the Pubmed data-base by searching following keywords: suburethral sling, midurethral sling, TVT, TOT, outpatient surgery, day surgery. RESULTS Seventy-eight percent to 88% of patients were continent postoperatively, and 6.8 to 12% of patients were significantly improved. No major complication occurred and minor complications were observed in 7.2 to 19.8% of patients. Eighty to 86.6% of patients experienced no complication. Seventy percent to 100% of patients were discharged on post operative day 0. The satisfaction rate was 89.4 to 95%. CONCLUSION Outpatient suburethral sling for stress urinary incontinence is suitable, effective, with a low complication rate, and with a high rate of satisfaction.
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Affiliation(s)
- S Serey-Eiffel
- Service d'urologie, CHU de Brest, 20, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - J-B Coquet
- Service d'urologie, CHU de Brest, 20, boulevard Tanguy-Prigent, 29200 Brest, France
| | - G Fournier
- Service d'urologie, CHU de Brest, 20, boulevard Tanguy-Prigent, 29200 Brest, France
| | - A Valeri
- Service d'urologie, CHU de Brest, 20, boulevard Tanguy-Prigent, 29200 Brest, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Brest, 20, boulevard Tanguy-Prigent, 29200 Brest, France
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Forzini T, Viart L, Alezra E, Saint F. [Erosive complications of mid urethral slings (MUS): 10 years of surgical experience]. Prog Urol 2015; 25:240-8. [PMID: 25617074 DOI: 10.1016/j.purol.2014.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 12/07/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Evaluation of the diagnostic and therapeutic management of erosive complications after mid urethral sling (MUS) procedure: vaginal erosions (VE), bladder (BE) and urethral (UE). METHODS Retrospective monocentric study concerning cohort of patients undergoing surgery from January 2002 to January 2013 supported for erosive complications of MSU: TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturateur Tape). RESULTS Sixteen patients were diagnosed for erosive complications: 7 VE, 6 BE and 3 UE. Dyspareunia and vaginal discharge were observed in 86% patients (n=6/7) with VE. Conservative treatment by vaginal approach was systematically performed in cases of vaginal erosion. After removal of material, 100% dyspareunia were corrected. Postoperative continence was maintained in 57% of patients (n=4/7). Urinary infection was the main symptom of patients with BE. Severe dysuria was present in 66% of patients with a UE (n=2/3). First-line therapy by endoscopic treatment was performed in 77% of patients (n=7/9) with a BE or UE. A second surgery was required in 42% of patients treated with endoscopic first-line therapy (n=3/7) because of a new exposure of MUS. Three of nine patients recurred their incontinence after first-line therapy (33%). CONCLUSION The removal of device exposed vaginally in case VE systematically corrected symptoms with about 60% of continence. In case of BE or UE, endoscopic treatment in first-line therapy was rarely definitive (42%) and recurrence of incontinence appeared in 30% cases.
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Affiliation(s)
- T Forzini
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France.
| | - L Viart
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire d'anatomie et d'organogénèse, UFR de médecine d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Alezra
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France
| | - F Saint
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France
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Hogewoning CRC, Gietelink L, Pelger RCM, Hogewoning CJA, Bekker MD, Elzevier HW. The introduction of mid-urethral slings: an evaluation of literature. Int Urogynecol J 2014; 26:229-34. [PMID: 25143007 DOI: 10.1007/s00192-014-2488-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/06/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate the degree and reliability of evidence used by manufacturers before the introduction of mid-urethral slings (MUS) onto the commercial market. Furthermore, minimum standards for marketed slings are recommended by evaluating recent suggestions for the introduction of gynecological meshes. METHODS A systematic literature search was conducted using PubMed and commercial internet search engines in order to identify slings introduced by the industry over the last decade. Moreover, manufacturers were contacted by email, mail, and phone to provide data from before the introduction of the slings onto the commercial market. Once contact had been initiated, a 6-month deadline was set for data collection. RESULTS Forty-one slings introduced between 1996 and 2012 were identified. Ten slings were described in a total of 20 studies with sample sizes varying from 10 to 368. The 41 MUS were produced by a total of 19 different companies. Seven companies never responded to recurrent emails, phone calls or other means of attempted contact. Thirty-one slings (76%) remained without any comparative pre-launch data. CONCLUSIONS Mid-urethral slings were often introduced without any scientifically proven basis or pre-launch research. The US Food and Drug Administration and the European authorities should undertake immediate action by imposing strict rules before the launch of new MUS comparable with those recently suggested for meshes used in vaginal prolapse surgery.
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Affiliation(s)
- Cornelis R C Hogewoning
- Department of Urology, Leiden University Medical Center, Postzone J3-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
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Önol SY, Sevket O, Önol FF, Erdem R, Tepeler A. Minimum 1-year results of mesh spiral-sling procedure in managing refractory and primary disabling stress urinary incontinence. Int Urogynecol J 2014; 25:1399-404. [PMID: 25135382 DOI: 10.1007/s00192-013-2224-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/01/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present our minimum 1-year results with a mesh spiral-sling procedure (MSSP) for managing refractory and disabling stress urinary incontinence (SUI) in women. METHODS Thirty-four women were treated with MSSP between 2007 and 2011. Six had incomplete data and were excluded from analysis. Study cohort comprised 21 women with refractory (mean number of previous surgeries 2.2; range 1-6) and seen with primary disabling SUI. All patients had marked intrinsic sphincter deficiency (ISD) with a Valsalva leak-point pressure (VLPP) <60 cm H2O. Preoperative workup included assessing the impact of voiding symptoms using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF), estimating the daily number of pads, and urodynamic studies. Preoperative and postoperative findings were compared using the Wilcoxon signed-rank test. RESULTS Intraoperative unilateral bladder-neck perforation occurred in two women during dorsal urethrolysis. With a mean follow-up of 26 months (range 12-48), SUI was cured in 71.4% of patients. Distal urethral reconstruction with vaginal mucosal flaps was performed in two patients with short urethral length (<2.5 cm) due to recurrence of SUI 10 months after MSSP. Mean ICIQ-SF score decreased from 19.4 ± 3.6 preoperatively to 7.3 ± 2.8 postoperatively (p = 0.001). Mean daily pad number decreased from 5.2 preoperatively to 1.2 postoperatively (p = 0.02). Urethral or vaginal erosion was not observed in any case during follow-up. CONCLUSION Using spiral slings may be a viable option in managing refractory and disabling SUI.
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Affiliation(s)
- Sinasi Yavuz Önol
- Department of Urology, Bezmi Alem Vakıf University Hospital, Istanbul, Turkey
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Nadeau G, Herschorn S. Management of Recurrent Stress Incontinence Following a Sling. Curr Urol Rep 2014; 15:427. [DOI: 10.1007/s11934-014-0427-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Williams ER, Klutke CG. Stress urinary incontinence: the evolution of the sling. Expert Rev Med Devices 2014; 5:507-23. [DOI: 10.1586/17434440.5.4.507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cox A, Herschorn S, Lee L. Surgical management of female SUI: is there a gold standard? Nat Rev Urol 2013; 10:78-89. [PMID: 23318365 DOI: 10.1038/nrurol.2012.243] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Many surgical options exist for women with stress urinary incontinence (SUI). The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings--inserted via a retropubic or transobturator approach--have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications. Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery. Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. Based on the literature a new gold standard first-line surgical treatment for women with SUI is the synthetic midurethral sling inserted through a retropubic or transobturator approach [corrected].
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Affiliation(s)
- Ashley Cox
- Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Room MG 408, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
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Kim JH, Doo SW, Yang WJ, Song YS. Laparoscopic transvesical excision and reconstruction in the management of mid-urethral tape mesh erosion and stones around the bladder neck: initial experiences. BJU Int 2012; 110:E1009-13. [PMID: 23046315 DOI: 10.1111/j.1464-410x.2012.11563.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Study Type--Prevalence (prospective cohort) Level of Evidence 1b. What's known on the subject? and What does the study add? Managing foreign bodies, including mesh and stones, after anti-incontinence surgery is important because complete removal is necessary to prevent infection and recurrence of stone formation. Traditionally, surgical management of such complications has involved excision using a transurethral approach, with or without a laparoscopic transvesical procedure. The study shows that mesh complications, including exposure and adherent stones, can be successfully treated and a fast recovery can be achieved using transvesical laparoscopic excision and reconstruction. Transvesical laparoscopy is especially suitable for cases that have a restricted visual field with cystoscopy; the technique allows complete removal of mesh/stones and reconstruction with the help of an excellent visual field. OBJECTIVES • To evaluate laparoscopic transvesical excision and reconstruction for the management of vesical mesh or stones around the bladder neck as complications of anti-incontinence intervention. • To compare the techniques, outcomes and recurrence rates of laparoscopic transvesical excision and reconstruction with published results from studies using laparoscopic transvesical procedures. PATIENTS AND METHODS • We conducted a retrospective review of three patients who underwent laparoscopic transvesical excision and reconstruction for vesical mesh and stones around the bladder neck. • Patients were identified from operating records including recorded video and electronic data records. • We also conducted a literature review of the available evidence on transvesical laparoscopy for lower urinary tract complications of anti-incontinence procedures. RESULTS • Between March 2005 and May 2011, three women underwent laparoscopic transvesical excision and reconstruction. All presented with storage symptoms and gross haematuria. The interval between surgery and the diagnosis of presence of a foreign body was 1-3 years. • Two women had previously undergone transobturator tape procedures and one had undergone a retropubic procedure. • Complete excision including the mucosa and muscle layer and reconstruction with intravesical sutures was achieved in all cases. • Storage symptoms were resolved within 3 days and haematuria was not observed. • None of the women had recurrent erosion at follow-up. CONCLUSIONS • Laparoscopic transvesical excision and reconstruction is a technically feasible method. • This procedure offers excellent visualization of mesh materials and stones, especially in cases of location near the anterior bladder neck. • In selected patients, laparoscopic transvesical excision and reconstruction is an acceptable technique for first-line treatment of complications of anti-incontinence procedures.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Cheng D, Liu C. Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up. Eur J Obstet Gynecol Reprod Biol 2012; 161:228-31. [DOI: 10.1016/j.ejogrb.2012.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 12/06/2011] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
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The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up. Int Urogynecol J 2011; 23:589-95. [PMID: 22109702 PMCID: PMC3332378 DOI: 10.1007/s00192-011-1605-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 10/28/2011] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence. Methods Seventy-seven patients, operated on from March 2008 to November 2009, were evaluated in this study. One-year post-operative data are presented. All patients suffered from predominant stress urinary incontinence. After 1 year, response was 74%. Evaluation was performed using a questionnaire consisting of the EuroQol-5 Dimensions, the Patient Global Impression of Improvement, the Incontinence Impact Questionnaire, the Urinary Distress Inventory, the Prolapse/Urinary Incontinence Sexual Questionnaire, short form, and the Defecation Distress Inventory. Results One year after surgery, 68% of the patients stated an improvement in their incontinence status, while only 44% stated to be completely dry. Conclusion The 1-year follow-up suggests that the MiniArc is less effective in the treatment of stress urinary incontinence than the TVT.
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Yoshizawa T, Yamaguchi K, Obinata D, Sato K, Mochida J, Takahashi S. Laparoscopic transvesical removal of erosive mesh after transobturator tape procedure. Int J Urol 2011; 18:861-3. [DOI: 10.1111/j.1442-2042.2011.02869.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Taweel WA, Rabah DM. Transobturator tape for female stress incontinence: follow-up after 24 months. Can Urol Assoc J 2011; 4:33-6. [PMID: 20165575 DOI: 10.5489/cuaj.08118] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this paper is to evaluate the effectiveness of transobturator vaginal tape (TOT) in the treatment of female stress urinary incontinence (SUI) and to analyze functional results and quality of life after 24 months follow-up. METHODS The study included all women with SUI who underwent a TOT procedure in which the sling passes from the obturator foramen from the outside to the inside, under general or regional anesthesia from December 2004 to January 2006. All study patients must have had a minimal follow-up of 24 months. The patients were prospectively evaluated, and the following factors were assessed: number of pads used per day, physical examination including pelvic examination, urinalysis, urogenital distress inventory (UDI-6), analog global satisfaction scale (GSS), pad weight test, and urodynamic studies including filling cystometry and Valsalva leak point pressure (VLPP) test. RESULTS Fifty-two consecutive patients who fulfilled the inclusion criteria underwent TOT procedure by 1 surgeon. The mean age was 50 +/-9 (range 37-72) and minimal follow-up was 24 months (range 24-30 months). Two patients were lost to follow-up after 12 months and 3 patients did not come for the 24-month evaluation. The mean operative time was 18 minutes +/-4 (range 15-31), with an average amount of bleeding 57 cc +/-22cc. Our results demonstrate a 92% cure or improvement rate after 12 months, and an 85% after 24 months. CONCLUSION The transobturator approach from outside to inside is a very effective treatment of SUI with low morbidity. However, longer follow-up in larger populations should assess the long-term reliability of this procedure.
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Affiliation(s)
- Waleed Al Taweel
- King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia, and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Chawla A. Transobturator tapes are preferable over transvaginal tapes for the management of female stress urinary incontinence: Against. Indian J Urol 2011; 25:554-7. [PMID: 19955693 PMCID: PMC2808672 DOI: 10.4103/0970-1591.57903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Midurethral placement of tension-free vaginal tapes with a transvaginal route for stress urinary incontinence achieves higher and better long-term success rates than the transobturator route. Bladder perforations are reported more in transvaginal tape (TVT) but incidences of vaginal erosions, extrusion, and groin pain are exceedingly more in TOT groups. There is no clear evidence that transobturator tape (TOT) is associated with less post-operative voiding problems than TVT. Major complications such as bowel injuries and significant vascular injuries with TVT are rare. TVT has been found to be superior to TOT and preferable in technically demanding conditions such as prior anti-incontinence operation failures, obese women, and very elevated and scarred lateral cul-de sac. TVT is always preferred in severe grades of stress urinary incontinence and with patients of intrinsic sphincter deficiency (ISD) with little or no urethral mobility.
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Affiliation(s)
- Arun Chawla
- Department of Urology, Kasturba Medical College, Manipal 576 104, Karnataka, India
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An Open-Label, Noncomparative, Multicenter Study to Evaluate Efficacy and Safety of NASHA/Dx Gel as a Bulking Agent for the Treatment of Fecal Incontinence. Gastroenterol Res Pract 2010; 2010:467136. [PMID: 21234379 PMCID: PMC3017894 DOI: 10.1155/2010/467136] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 10/01/2010] [Accepted: 11/04/2010] [Indexed: 12/17/2022] Open
Abstract
Fecal incontinence (FI) is the involuntary loss of rectal contents through the anal canal. Reports of its prevalence vary from 1–21%. Studies, have demonstrated a positive effect on FI symptoms with injectable bulking agents. This study evaluated the safety and efficacy of NASHA/Dx gel in the treatment of FI. One hundred fifteen eligible patients suffering from FI received 4 injections of 1 mL NASHA/Dx gel. Primary efficacy was based on data from 86 patients that completed the study. This study demonstrated a ≥50% reduction from baseline in the number of FI episodes in 57.1% of patients at 6 months, and 64.0% at 12 months. Significant improvements (P < .001) were also noted in total number of both solid and loose FI episodes, FI free days, CCFIS, and FIQL scores in all 4 domains. The majority of the treatment related AEs (94.9%) were mild or moderate intensity, and (98.7%) of AEs resolved spontaneously, or following treatment, without sequelae. Results of this study indicate NASHA/Dx gel was efficacious in the treatment of FI. Treatment effect was significant both in reduction of number of FI episodes and disease specific quality of life at 6 months and lasted up to 12 months after treatment.
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[Sub-urethral sling in the treatment of female urinary incontinence: which? how?]. ACTA ACUST UNITED AC 2010; 38:607-19. [PMID: 20880735 DOI: 10.1016/j.gyobfe.2010.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 05/03/2010] [Indexed: 11/23/2022]
Abstract
Review of the literature that formed the basis for drafting the guideline on the sub-uretral sling in the first-line surgical treatment of female stress urinary incontinence. Medline database query since the introduction of TVT on the questions of various chapters and sub-chapters of the present article. The use of tapes made of polypropylene monofilament exclusively, knitted, is recommended to the exclusion of any other material. Regarding the choice of procedure, the objective cure rate of transobturator and retro-pubic routes cannot be evaluated clearly because of vague evaluation criteria from one study to another. Without adequate clinical trials proving their efficacy and safety, the mini-bands can so far be recommended to treat female stress urinary incontinence. Moderate overweight does not affect the results of laying tape. In patients with severe obesity, surgery to correct obesity is even better than surgery for incontinence. Age is not a contra-indication. If the patient is young and nulliparous, it is reasonable to advise her to postpone surgery after her last pregnancy. In case of multiparous patient, the risk of vaginal delivery does not seem sufficient to suggest a cesarean section. To conclude, sub-urethral slings are the first-line surgical treatment of female stress urinary incontinence.
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ARK C, GÜNGÖRDÜK K, CELEBı I. Results of TOT operations alone and combined with other vaginal surgical procedures. Aust N Z J Obstet Gynaecol 2010; 50:550-5. [DOI: 10.1111/j.1479-828x.2010.01221.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee KS, Lee YS, Seo JT, Na YG, Choo MS, Kim JC, Seo JH, Yoon JM, Lee JG, Kim DY, Yoo ES, Min KS, Hong JY, Lee JZ. A Prospective Multicenter Randomized Comparative Study Between the U- and H-type Methods of the TVT SECUR Procedure for the Treatment of Female Stress Urinary Incontinence: 1-Year Follow-Up. Eur Urol 2010; 57:973-9. [PMID: 20206437 DOI: 10.1016/j.eururo.2010.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
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Rivalta M, Sighinolfi MC, Micali S, De Stefani S, Bianchi G. Sexual Function and Quality of Life in Women with Urinary Incontinence Treated by a Complete Pelvic Floor Rehabilitation Program (Biofeedback, Functional Electrical Stimulation, Pelvic Floor Muscles Exercises, and Vaginal Cones). J Sex Med 2010; 7:1200-8. [DOI: 10.1111/j.1743-6109.2009.01676.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hermieu JF, Debodinance P. Recommandations pour le traitement chirurgical de l’incontinence urinaire d’effort de la femme par bandelettes sous-urétrales. Prog Urol 2010; 20 Suppl 2:S112-31. [DOI: 10.1016/s1166-7087(10)70006-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Debodinance P, Hermieu JF, Lucot JP. Traitement chirurgical de première intention de l’incontinence urinaire d’effort de la femme. ACTA ACUST UNITED AC 2009; 38:S182-200. [DOI: 10.1016/s0368-2315(09)73578-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Su TH, Huang WC, Lee MY, Lin TY, Chang HC, Chen CP. Tension-free vaginal tape-obturator procedure for treatment of severe urodynamic stress incontinence: Subjective and objective outcomes during 2âyears of follow-up. J Obstet Gynaecol Res 2009; 35:1077-82. [DOI: 10.1111/j.1447-0756.2009.01065.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Huang WC, Su TH, Lin TY, Hsieh CH, Chen SS, Lee MY. Functional and anatomic assessments for transobturator vaginal tape inside-out operation for urodynamic stress incontinence. J Obstet Gynaecol Res 2009; 35:946-52. [DOI: 10.1111/j.1447-0756.2009.01032.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kaelin-Gambirasio I, Jacob S, Boulvain M, Dubuisson JB, Dällenbach P. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up. BMC WOMENS HEALTH 2009; 9:28. [PMID: 19781074 PMCID: PMC2760512 DOI: 10.1186/1472-6874-9-28] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 09/25/2009] [Indexed: 11/10/2022]
Abstract
Backround The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. Methods It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®). Follow-up information was available for 225 (96.6%) women. Results There were few per operative complications. Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001). Conclusion Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
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Affiliation(s)
- Isabelle Kaelin-Gambirasio
- Department of Gynecology and Obstetrics, Division of Gynecology, Perineology Unit, University Hospitals of Geneva, University of Geneva, Switzerland.
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Lapouge O, Bram R, Hocke C, Ballanger P. [Management of erosive complications after tension-free vaginal tape procedure]. Prog Urol 2009; 19:193-201. [PMID: 19268258 DOI: 10.1016/j.purol.2008.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 10/16/2008] [Accepted: 11/26/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the management of patients with an erosive complication after tension free vaginal tape. To establish a diagnostic approach, describe the results on symptoms and continence after a conservative surgery. METHODS Retrospective descriptive study of 38 patients supported for complications after suburethral synthetic sling. We have diagnosed 12 erosions vaginal and five bladder erosions. Patients have been treated from a recovery surgery according to a conservative approach (partial resection or endoscopic section). RESULTS Of the 12 patients with a vaginal erosion, 10 expressed symptoms in relation with their erosion. After partial resection, eight patients (80% of patients with symptomatic erosion) did not have more complain. Of these, 50% were continent, the other with mostly a slight recurrence accessible to a second suburethral sling. First endoscopic section was a minimally invasive option for bladder erosion. However, an only cystoscopic approach seemed to be not sufficient to cut the sling as far as possible. After section, two patients have been treated from a laparotomy with bladder dissection, one for immediate outcome unsatisfactory, the other for reccurent symptoms. The results for continence were excellent as the suburethral portion was not resected. CONCLUSION Our study showed the importance of regular clinical surveillance, feasibility and the relative success of this conservative approach. The technical feasability and the increasing number of patients must not forget to respect good indication and rigorous technique. These complications invite us to moderate our indications especially for young patients.
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Affiliation(s)
- O Lapouge
- Service de chirurgie urologique, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Lo TS. Combined Pelvic Reconstructive Surgery and Transobturator Tape (Monarc) in Women with Advanced Prolapse and Urodynamic Stress Incontinence: A Case Control Series. J Minim Invasive Gynecol 2009; 16:163-8. [PMID: 19249703 DOI: 10.1016/j.jmig.2008.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 11/29/2008] [Accepted: 12/02/2008] [Indexed: 12/01/2022]
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China.
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The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update. Int Urogynecol J 2008; 20:337-48. [DOI: 10.1007/s00192-008-0753-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
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Sivanesan K, Sathiyathasan S, Ghani R. Transobturator tension free vaginal tapes and bladder injury. Arch Gynecol Obstet 2008; 279:5-7. [DOI: 10.1007/s00404-008-0653-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 04/08/2008] [Indexed: 10/21/2022]
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Female Urology @ European Urology: What's Going On? Eur Urol 2008; 54:501-4. [DOI: 10.1016/j.eururo.2008.03.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 03/21/2008] [Indexed: 11/30/2022]
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Joutsiniemi T, Ala-Nissilä S, Räty R, Laurikainen E, Kiilholma P. Transobturatoric tape procedure for female stress urinary incontinence. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0418-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Geoffrion R, Murphy M, Mainprize T, Ross S. Closing the chapter on obtape: a case report of delayed thigh abscess and a literature review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:143-147. [PMID: 18254996 DOI: 10.1016/s1701-2163(16)32738-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a case of delayed abscess formation 33 months after Obtape transobturator tape insertion, and we review the relevant literature. CASE A 73-year-old woman presented with groin pain, swelling, and purulent discharge 33 months after Obtape insertion. Examination showed a vaginal erosion and right groin abscess. Oral antibiotics resulted in significant symptomatic improvement. The patient underwent complete tape removal and drainage of infection. She continues to suffer from urinary incontinence. CONCLUSION Abscess formation and undiagnosed mesh erosion can occur up to 33 months after Obtape insertion, longer than previous reports have described. This highlights the need for continued vigilance in patients who have undergone Obtape insertion. Vaginal mesh erosions warrant careful repair in order to avoid delayed infectious complications.
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Affiliation(s)
- Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | - Magnus Murphy
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | - Tom Mainprize
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | - Sue Ross
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
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Rapp DE, Kobashi KC. The evolution of midurethral slings. ACTA ACUST UNITED AC 2008; 5:194-201. [DOI: 10.1038/ncpuro1052] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 01/22/2008] [Indexed: 11/09/2022]
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Tension-free vaginal tape obturator: midterm data on an operative procedure for the cure of female stress urinary incontinence performed on 100 patients. J Minim Invasive Gynecol 2008; 15:92-6. [PMID: 18262152 DOI: 10.1016/j.jmig.2007.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 10/21/2007] [Accepted: 10/29/2007] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the midterm therapeutic results of a minimally invasive anti-incontinence operative procedure, the tension-free vaginal tape (TVT) obturator. DESIGN With this prospective, observational, and consecutive patient series, the TVT obturator procedure was performed by the same surgeon on 100 patients. Follow-up lasted 30 to 36 months. SETTING Operative theaters of Assuta medical centers private hospitals. PATIENTS One hundred female patients with urodynamically proven stress urinary incontinence. INTERVENTIONS TVT obturator operations were performed for all patients. MEASUREMENTS AND MAIN RESULTS Demographic and therapeutic aspects of the patient group data were evaluated. Clinical signs for bowel, urethral, or bladder injuries were undetectable with this TVT obturator patient group. Intraoperative bleeding, postoperative field infections, or postoperative pelvic floor relaxations were not noted. The therapeutic failure rate for the TVT obturator procedure was 8.0% (8 of 100 patients) after 1 year, whereas the midterm failure rate was 10.8% (10 of 93 patients). Six of the 10 patients with TVT obturator failure underwent interval TVT operations with satisfactory results. The overall midterm satisfaction rate for this study group of patients was 89.2% (83 of 93 patients), 6 (6.5%) of those patients were improved only, yet still with minimal residual urinary leakage. CONCLUSION Use of the TVT obturator, a midurethral sling, did not involve bladder penetration and was complicated by a low rate of postoperative outlet obstruction. The midterm therapeutic results and the cost-effectiveness of the TVT obturator appear similar to previously reported midurethral sling operations. Long-term comparative data collection is required to enable drawing solid conclusions regarding the appropriate position of this operative technique within the spectrum of antiincontinence operations.
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The use of polypropylene mesh as a transobturator sling for the treatment of female stress urinary incontinence (early experience with 40 cases). Int Urogynecol J 2008; 19:833-8. [PMID: 18183340 DOI: 10.1007/s00192-007-0539-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
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Yeung P, Sokol A, Walton B, Iglesia C. Thigh abscess mistaken for sarcoma following transobturator tape: a case report and literature review. J Minim Invasive Gynecol 2007; 14:657-9. [PMID: 17848332 DOI: 10.1016/j.jmig.2007.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 04/17/2007] [Indexed: 10/22/2022]
Abstract
A 44-year-old female, 1 year status-post ObTape transobturator mid-urethral sling, was evaluated by orthopaedic oncology and urology for persistent thigh pain and a left thigh mass. Multiple muscle biopsies were inconclusive, raising concern for inflammatory sarcoma. After serial débridements of the thigh abscess, sling material was found in the obturator space, which gave the diagnosis. Health care providers, both gynecologic and nongynecologic, need to be aware of serious complications of transobturator slings that may present in atypical ways.
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Affiliation(s)
- Patrick Yeung
- Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC 20007, USA.
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Afonso JS, Martins PALS, Girao MJBC, Natal Jorge RM, Ferreira AJM, Mascarenhas T, Fernandes AA, Bernardes J, Baracat EC, Rodrigues de Lima G, Patricio B. Mechanical properties of polypropylene mesh used in pelvic floor repair. Int Urogynecol J 2007; 19:375-80. [PMID: 17846702 DOI: 10.1007/s00192-007-0446-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study was the comparison of the stiffness of different meshes under two types of mechanical tests. Five different mesh types were mechanically tested. The methods used consisted on uniaxial tension test (tensile stiffness) and tape ring tests, experimental continuous compression of the mesh loops (flexural stiffness). The most significant difference of tensile stiffness behaviour appears between Aris and TVTO. From the analysis of the experimental data, we divided the flexural stiffness, in two main groups. The first group includes Auto Suture and Aris meshes. The two meshes seem to have a similar flexural behaviour. The second group includes TVTO, Uretex and Avaulta. The difference between these two groups is clearly evident comparing TVTO and Aris. This study shows that there are significant differences on the mechanical properties between urogynecology meshes.
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Affiliation(s)
- J S Afonso
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
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Gomelsky A, Dmochowski RR. Biocompatibility assessment of synthetic sling materials for female stress urinary incontinence. J Urol 2007; 178:1171-81. [PMID: 17698123 DOI: 10.1016/j.juro.2007.05.123] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE We evaluated the performance and complications of currently available synthetic sling materials with a focus on in vitro and in vivo biocompatibility, and acceptance in the human body. MATERIALS AND METHODS We reviewed the MEDLINE database for relevant literature pertaining to various synthetic sling materials. The Food and Drug Administration regulations regarding the regulation and biocompatibility testing of synthetic meshes were also reviewed. RESULTS Many synthetic meshes used for sling construction were introduced before rigorous Food and Drug Administration regulations were passed and, thus, some became associated with unique complications. Most meshes used in pubovaginal and mid urethral sling surgery are associated with high short-term success rates and relatively few intraoperative complications. Despite modifications and additives, slings constructed from polytetrafluoroethylene and polyethylene are poorly accepted by the human body. Flexible, macroporous, polypropylene meshes appear to integrate more completely with human tissue than other synthetic materials. However, multifilament and nonknitted polypropylene slings may integrate poorly. CONCLUSIONS The composition, weave and pore size of each material are unique. These properties are responsible for the strength and durability of the material, as well as the ultimate acceptance and incorporation in the human body. Each material should be individually evaluated and patients should be counseled appropriately before implantation.
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Affiliation(s)
- Alex Gomelsky
- Department of Urology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA
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Transobturator suburethral tapes in the management of urinary incontinence: success, safety and impact on sexual life. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10397-007-0303-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andonian S, St-Denis B, Lemieux MC, Corcos J. Prospective Clinical Trial Comparing Obtape® and DUPS to TVT: One-Year Safety and Efficacy Results. Eur Urol 2007; 52:245-51. [PMID: 17234331 DOI: 10.1016/j.eururo.2006.12.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 12/30/2006] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Obtape and DUPS are modifications of the original TVT procedure. To test these new products in terms of safety and efficacy, we designed a prospective clinical trial with a follow-up of at least 1 yr. METHODS We randomized 190 consecutive females with SUI for this study. They were evaluated by history, ICIQ-SF, physical examination, cystoscopy, UDS, and the 1-h pad test. Patients were reevaluated at 1, 6, and 12 mo. The ICIQ-SF and pad test were repeated at 1-yr follow-up. RESULTS There were 78, 32, and 80 patients in the Obtape, DUPS, TVT arms, respectively. An interim analysis after 32 patients in each arm indicated postoperative retention rates of 3 (9.4%), 6 (18.8%), and 4 (12.5%) patients in Obtape, DUPS, and TVT groups, respectively. Because of higher retention rate and suprapubic discomfort, DUPS was discontinued. At the end of the study, complete retention rates were 6 (7.8%), 6 (18.8%), and 6 (7.5%) in Obtape, DUPS, and TVT, respectively. TVT was the only procedure with bladder perforations at a rate of 14%. However, Obtape and DUPS were associated with more postoperative complications including complete retention, urethrolysis, hematoma, mesh erosion, UTI, and wound infection (13%, 28%, and 8%; p< or =0.025). At 1 yr, 83%, 94%, and 86% of patients in the Obtape, DUPS, and TVT groups were objectively cured (p>0.05). CONCLUSIONS TVT was the only procedure associated with bladder perforation, but there were more postoperative complications with Obtape and DUPS. No statistically significant differences in cure rates were observed at 1-yr follow-up. Longer follow-up is needed to confirm these results.
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Affiliation(s)
- Sero Andonian
- Department of Urology, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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45
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2007; 17:287-90. [PMID: 17558274 DOI: 10.1097/mou.0b013e3281fbd54d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Juang CM, Yu KJ, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL. Efficacy Analysis of Trans-obturator Tension-free Vaginal Tape (TVT-O) Plus Modified Ingelman-Sundberg Procedure versus TVT-O Alone in the Treatment of Mixed Urinary Incontinence: A Randomized Study. Eur Urol 2007; 51:1671-8; discussion 1679. [PMID: 17254697 DOI: 10.1016/j.eururo.2007.01.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The treatment of women with mixed urinary incontinence still poses a great challenge. This study evaluated surgical outcomes of combined trans-obturator tension-free vaginal tape (TVT-O) and modified Ingelman-Sundberg (IS) procedure for the treatment of mixed urinary incontinence. METHODS A randomized controlled trial was conducted. Ninety-six women diagnosed with mixed incontinence were randomized, with 49 allocated to TVT-O plus IS and 47 to TVT-O alone. A baseline urodynamic study and evaluation of quality of life (QOL) was conducted. The primary outcome measure was objective assessment of surgical outcomes, and the secondary outcome measure was warning time. RESULTS Objective surgical response rate was significantly higher in the TVT-O plus IS group than in the TVT-O alone group (84.8% vs. 62.8%; p=0.019). Furthermore, a significant increase in warning time was observed in the TVT-O plus IS group (from 3.9 to 9.4 min; p=0.006), but the increase in warning time within the TVT-O alone group was not statistically significant (from 4.3 to 4.5 min; p=0.695). Postoperative complications were similar in the two study groups with respect to pelvic hematoma, nerve injury, sepsis, mesh erosion, and fistula formation. However, fever occurred more frequently in the TVT-O plus IS group (30.4% vs. 20.9%; p=0.026). CONCLUSIONS Mixed urinary incontinence can potentially be treated with a one-step combined surgery using trans-obturator sling plus modified IS procedure. Although surgical time and blood loss were significantly increased in the TVT-O plus IS group, overall morbidity was not significantly increased.
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Affiliation(s)
- Chi-Mou Juang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and Department of Epidemiology, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
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Giberti C, Gallo F, Cortese P, Schenone M. Transobturator tape for treatment of female stress urinary incontinence: objective and subjective results after a mean follow-up of two years. Urology 2007; 69:703-7. [PMID: 17445655 DOI: 10.1016/j.urology.2007.01.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 10/08/2006] [Accepted: 01/05/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To verify the objective and subjective outcomes of transobturator tape (TOT) in the treatment of female stress urinary incontinence due to urethral hypermobility. METHODS A total of 108 consecutive patients with stress urinary incontinence (mean age 58 +/- 4.5 years), who underwent the TOT procedure (43 patients received the ObTape, 55 patients the Monarc, and 10 patients the I-STOP sling) from June 2002 to December 2004, were assessed in December 2005. Before surgery, the patients were evaluated by history, physical examination, stress test, cotton swab test (Q-Tip test), and ultrasonography. After surgery, the compilation of a specific quality-of-life questionnaire was also included. Of the 108 patients, 35 had previously undergone urogynecologic surgery; associated prolapse was repaired simultaneously in 45 patients. The outcomes were analyzed considering five postoperative aspects: obstructive symptoms, irritative symptoms, urinary continence, pain, and satisfaction. RESULTS Postoperatively, 74% reported minimal obstructive symptoms, 78.7% had no urge symptoms, and de novo urgency occurred in 14.8%. Objective continence rates were increased significantly (80%), although the subjective rate was significantly greater (92%). Also, 88% of patients reported no pelvic pain, and only 7.3% reported dyspareunia; 88% of patients were significantly satisfied with the TOT procedure. Regarding complications, vaginal erosions were reported, using the ObTape, in 6.4% of patients, sling rejection in 3.8%, and incorrect positioning or sliding of the sling in 6.4%. Morbidity did not seem to be affected by previous or associated surgery. CONCLUSIONS The TOT procedure is a simple, safe, and effective technique for the treatment of stress urinary incontinence due to urethral hypermobility. Our data have demonstrated good global success with a low rate of minor complications.
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Affiliation(s)
- Claudio Giberti
- Department of Nephrourology, Institute of Urology, San Paolo Hospital, Savona, Italy
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Transobturator tape as a day surgery procedure: a case control study. Int J Surg 2007; 5:152-4. [PMID: 17509495 DOI: 10.1016/j.ijsu.2006.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 06/16/2006] [Accepted: 06/23/2006] [Indexed: 11/29/2022]
Abstract
This study aims to assess the suitability of the transobturator tape (TOT) as a day surgery procedure. A retrospective study of all the patients who underwent TOT as a day surgery procedure, at a tertiary referral centre in the south-west of Scotland, over a 3-year period (August 2002-July 2005). The outcome measures were as follows: complication rates (both intra- and immediate postoperative), voiding dysfunction rates, analgesic requirements and unscheduled in-patient ward admission following the procedure. One hundred and sixty-seven case notes were examined; the mean operating time was 14.7 min (range: 12-28 min, median: 14 min). 97.8% of patients had blood loss <100 ml and the mean blood loss was 54 ml (range: 10-500 ml). None of the patients had major complications such as urethral or bladder injury or anaesthetic complications. 79.6% of patients had satisfactory postoperative voiding pattern achieved within the time frame of the DSU (08:30-17:00 hours). No patient had complete urinary retention. However, 34 patients (20.4%) failed to achieve satisfactory voiding within that time frame and warranted in-patient admission. Three other patients required in-patient admission; the reasons being vaginal bleeding (n=1), postoperative nausea and vomiting (n=1) and postoperative pain (n=1). Therefore, a total of 37 patients required in-patient ward admission, with an admission rate of 22.2%. In conclusion, the transobturator tape procedure is suitable as a day surgery procedure in selected patients. There is minimal peri-operative morbidity, and nearly 80% of patients are discharged home within the scheduled time frame.
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Zullo MA, Plotti F, Calcagno M, Marullo E, Palaia I, Bellati F, Basile S, Muzii L, Angioli R, Panici PB. One-Year Follow-up of Tension-free Vaginal Tape (TVT) and Trans-obturator Suburethral Tape from Inside to Outside (TVT-O) for Surgical Treatment of Female Stress Urinary Incontinence: A Prospective Randomised Trial. Eur Urol 2007; 51:1376-82; discussion 1383-4. [PMID: 17110021 DOI: 10.1016/j.eururo.2006.10.066] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of stress urinary incontinence (SUI) for complications (primary end point) and success rate (secondary end point). METHODS Seventy-two consecutive patients, with a mean age of 53.2 yr (range: 38-69 yr) and affected by SUI, were included in this randomised controlled trial. After preoperative assessment, patients were randomly allocated to the TVT or TVT-O procedure. Operative time, perioperative complications, and hospital stay were prospectively recorded. Cure of SUI was defined as no leakage of urine during the stress test at urodynamic testing at the 12-mo evaluation. The Wilcoxon signed rank sum test, Mann-Whitney U test, McNemar test, and Fisher exact test were used to verify statistical significance, set at p<0.05. RESULTS All patients were evaluable at the 12-mo follow-up. The characteristics of patients were well balanced between groups after randomisation. The mean operative time was significantly shorter in the TVT-O group. Perioperative complications were significantly more common after the retropubic approach (5% and 27% in TVT-O and TVT groups, respectively, p<0.04). The groups did not differ significantly in intraoperative blood loss, hospital stays, and time to return to normal activities. Sixty-five patients (90%) were successfully treated for SUI 12 mo after the operation (89% and 91% for TVT-O and TVT groups, respectively). CONCLUSIONS Both techniques appear to be equally effective in the surgical treatment of SUI. However, TVT-O had a shorter operative time and lower overall perioperative complication rate.
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Affiliation(s)
- Marzio Angelo Zullo
- Department of Obstetrics and Gynecology, University of Rome Campus Bio-medico, Via Longoni 83, 00155 Rome, Italy.
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Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, Bini V, Kocjancic E. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol 2007; 52:1481-90. [PMID: 17482343 DOI: 10.1016/j.eururo.2007.04.059] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 04/18/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This prospective, multicentre, randomised study compared the safety and success rate of tension-free vaginal tape (TVT) and transobturator tape (TOT) in treatment of female stress urinary incontinence. METHODS Of 148 women, 73 were randomised to TVT and 75 to TOT. Preoperative workups included case history, clinical examination, Urogenital Distress Inventory and Impact Incontinence Quality of life questionnaires, 1-h pad test, pelvic ultrasound, and urodynamics. Intra- and postoperative complications were the primary end point; subjective and objective changes in SUI, and postoperative voiding dysfunctions were secondary end points. Patients were classified into two main categories: dry (no leakage during clinical and/or stress test and/or reported by patients) versus wet. Patients who referred being wet were separated into "improved" or "failure" on subjective analysis. Other outcome variables were quality of life questionnaires and VAS scale. Clinical checkups were conducted at 3, 6, 12 mo, and then annually. RESULTS Both techniques are safe and no significant differences emerged in intra- and postoperative complications. At a mean follow-up of 31 mo, the overall objective cure (dry) was 71.4% for TVT and 77.3% for TOT (p=ns). When one considered "dry" plus "wet but improved," these values increased to 90% and 90.6%, respectively (p=ns). Median satisfaction rate was 9 (range: 1-10) for both procedures. Postoperative storage symptoms are a controversial issue; they persisted in 44% of patients in TVT group versus 24% in TOT group (p<0.053). CONCLUSIONS TOT appears as safe and effective as TVT in surgery for female SUI, with minimal complications at mean follow-up of 31 mo.
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Affiliation(s)
- Massimo Porena
- Department of Medical-Surgical Specialties and Public Health, Section of Urology and Andrology, University of Perugia, Perugia, Italy
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