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Cardot V, Campagne-Loiseau S, Roulette P, Peyrat L, Vidart A, Wagner L, Thuillier C, Klap J, Hurel S, Hermieu JF, Girard F, Even L, Donon L, Charles T, Tibi B, Bosset PO, Berrogain N, Meyer F, Cornu JN, Deffieux X. 2021 opinion from the CUROPF on THE efficacy and safety of mid-urethral slings used in women WITH urinary stress incontinence. Prog Urol 2022; 32:247-257. [PMID: 34920924 DOI: 10.1016/j.purol.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.
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Affiliation(s)
- V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - S Campagne-Loiseau
- Service de gynécologie obstétrique, CHU Estaing, Clermont Ferrand, 1, place Lucie et Raymond-Aubrac, 63000 Clermont Ferrand, France
| | - P Roulette
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - L Peyrat
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Servie d'urologie, CHU Carémeau, place du Pr Robert Debré, 30029 Nîmes, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 20, route de Boussy Saint-Antoine, 91480 Quincy sous Sénart, France
| | - S Hurel
- Service d'urologie, hôpital Européen Georges-Pompidou (AP-HP), 20, rue Leblanc, 75015 Paris, France
| | - J F Hermieu
- Service d'urologie, hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - F Girard
- Service d'urologie, clinique oudinot fondation Cognacq-Jay, 2 rue Rousselet, 75007 Paris, France
| | - L Even
- Cabinet d'urologie, Espace Santé 3, 521, avenue de Rome, 83500 La Seyne-sur-Mer, France
| | - L Donon
- Service d'urologie, Polyclinique de la Côte Basque Sud, 7, rue Léonce Goyetche, 64500 Saint Jean de Luz, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 2, rue de la Milétrie, 86021 Poitiers, France
| | - B Tibi
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - P O Bosset
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - N Berrogain
- Service d'URologie, Clinique Ambroise Pare, 387, route de Saint-Simon, 31100 Toulouse, France
| | - F Meyer
- Service d'urologie, hôpital Saint Louis (APHP), 1, avenue Claude Vellefaux, 75010 Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - X Deffieux
- Service de gynécologie obstétrique, hôpital Antoine-Béclère (APHP), 157, rue de la Porte de Trivaux, 92140 Clamart, France.
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Hermieu N, Hermieu JF, Schoentgen N, Aoun R, Xylinas E, Deffieux X, Fernandez H, Cosson M, Gamé X, Peyronnet B, Ouzaid I. [Trends in the use of midurethral slings after the new legislation: A nationwide survey]. Prog Urol 2021; 31:422-429. [PMID: 33863637 DOI: 10.1016/j.purol.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The French Department of Health published on October 23, 2020 a decree governing acts associated with mid-urethral sling (MUS) operations. The aim of this study was to evaluate the changes in practice following this new legislation. METHODS A cross-sectional study was carried out among French urologists and gynecologists using an online survey to collect changes in practices since the publication of the decree. RESULTS From January to February 2021, 436 surgeons participated in the survey. Among these surgeons, 87% were aware of the new legislation and 56% of them considered the decree as useless. The order resulted in an increase in working time in 81% of cases. Among these surgeons, 66% of the surgeons worked in tertiary referral centers for the management of incontinence, of which 55% had a multidisciplinary meeting in urogynecology. Among the surgeons, 31% considered this meeting to be useful but 80% considered that it did not lead to any change in surgical indications, even though 33% of complications of BSU were discussed there. In conclusion, 61% of surgeons felt more reluctant to schedule a BSU placement with this new legislation. CONCLUSION The majority of questioned surgeons considered the decree as useless. It generated few changes in practices which already respected the law on information, consultation, consent, experience and training. Most urologists and gynecologists are more reluctant to offer MUS after this new legislation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Hermieu
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - J-F Hermieu
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - N Schoentgen
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - R Aoun
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - E Xylinas
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - X Deffieux
- Service de gynécologie obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - H Fernandez
- Service de gynécologie et obstétrique, hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - M Cosson
- Service de gynécologie, CHU Jeanne-de-Flandre, Lille, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Toulouse, France
| | - B Peyronnet
- Service de chirurgie urologique, CHU de Rennes, Rennes, France
| | - I Ouzaid
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France.
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Chartier-Kastler E, Guillot-Tantay C, Phe V. [Surgical management of complications related to Mid-urethral slings and functional results. N. Hermieu, N. Schoentgen, R. Aoun, P. Neveu, Y. Grassano, C. Egrot, A. Kassem, E. Xylinas, I. Ouzaid, J.F. Hermieu. Progrès en urologie (2020) 30, 402-410]. Prog Urol 2021; 31:241-242. [PMID: 33468414 DOI: 10.1016/j.purol.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- E Chartier-Kastler
- Service d'urologie, Sorbonne université, GH Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - C Guillot-Tantay
- Service d'urologie, Sorbonne université, GH Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Phe
- Service d'urologie, Sorbonne université, GH Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
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