Transvaginal Bone-Anchored Sling Procedure: 4 Years of Follow-Up on More than 200 Consecutive Patients

Use of three types of synthetic mesh material in sling surgery: a prospective randomized clinical trial evaluating effectiveness and complications

OBJECTIVE

The aim of this study was to determine the surgical success and complication rates of mixed type of mesh materials compared with Prolene mesh in sling surgery over a 4-year follow-up period.

MATERIAL AND METHODS

Between 2005 and 2007, broad-based double-forced sling operations were performed in 144 women with stress incontinence using three different types of mesh material. Group I consisted of 48 patients in whom Vypro® mesh (Ethicon, USA) was used; group II of 48 patients in whom Ultrapro® mesh (Ethicon) and group III of 48 patients in whom Prolene® light mesh (Ethicon) was used. The patients' data and the success of the operation were evaluated based on the 24 h pad test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scoring and Korman questionnaire analysis.

RESULTS

The ICIQ-SF score, the number of pads used and the results of 24 h pad test were statistically lower in group II at postoperative month 48 (p < 0.05). The rate of postoperative complications was lower in Group II than in the other groups (p < 0.05). The continence rates of groups I, II and III were 84.7%, 91.6% and 85.1%, respectively, in the 48th postoperative month.

CONCLUSIONS

Ultrapro mesh can be used in sling surgery owing to its higher success rates, and lower vaginal and urethral extrusion and de novo urgency rates, which have also been shown in clinical studies.

Female incontinence: long-term results of slings

PURPOSE OF REVIEW

Several different sling procedures are currently in use and most of them are newly developed. Despite the fact that they are widely in use, knowledge about their long-term efficacy, morbidity, and functional sequeal is scarce. The aim of the present review is to provide an update of several different procedures.

RECENT FINDINGS

The tension-free vaginal tape is the best studied and documented procedure with excellent long-term outcome data and low rates of complications. Tension-free vaginal tape appears to be followed by significantly higher objective cure rates than transobturator tape. Concerning comparison of different types of transobturator tape, no significant differences were found so far. Minislings still need to be evaluated concerning long-term safety and efficacy.

SUMMARY

Tension-free vaginal tape and transobturator tape are equally effective; for assessment of new approaches, surgical long-term data are mandatory.

Porcine small intestinal submucosa implant in pubovaginal sling procedure on 48 consecutive patients: long-term results

OBJECTIVE

The long-term efficacy of pubovaginal sling (PVS) procedure with porcine small intestinal submucosa (SIS) implant was retrospectively assessed.

STUDY DESIGN

Forty-eight patients with SUI underwent a pubovaginal sling with SIS. Patient evaluation included history, physical examination with stress test and prolapse assessment by Baden-Walker classification, routine laboratory tests, 24h-pad test, and multichannel urodynamic measurement. Postoperatively the patients were classified as cured, improved and unchanged or failed. A King's Health Questionnaire (KHQ) was performed to verify post-operatively the quality of life of these patients.

RESULTS

At median follow-up of 76 months 33/48 (69%) were cured, 6/48 (12%) were improved while 9/48 (19%) were failed or unchanged. No urinary retention or dyspareunia was reported and no vaginal erosion or adverse tissue reaction was detected. The descriptive statistics of KHQ scores by dimensions was done in 32/48 patients (67%). Failed or unchanged patients showed worse scores than cured and improved patients in all KHQ dimensions showing an overall overlapping between objective and subjective results although these findings are weakened due to the lack of a preoperative evaluation of QoL.

CONCLUSIONS

PVS procedure using SIS cannot offer a durable option for the treatment of SUI as reported by the current mininvasive techniques.

[Management of chronic pelvic and perineal pain after suburethral tape placement for urinary incontinence]

INTRODUCTION

The surgical treatment of stress urinary incontinence is essentially based on TVT or TOT suburethral tape placement. The purpose of this article is to review the literature on the diagnostic and therapeutic approach to chronic pelvic and perineal pain following suburethral tape placement for urinary incontinence.

MATERIAL AND METHODS

A comprehensive review of the literature was performed by searching Pubmed for articles on pelvic and perineal pain following suburethral tape placement.

RESULTS

The role of suburethral tape in the pathogenesis of pain is essentially based on the fact that pain occurs immediately or over the days following tape placement. The clinical features are usually fairly nonspecific, with pelvic myofascial pain, possibly associated with direct or indirect nerve lesions (obturator nerve or pudendal nerve). Local infiltration of anaesthetic along the tape is performed for diagnostic purposes to confirm the aetiology of the pain and can also have a temporary therapeutic efficacy. Surgical removal of the tape was performed with satisfactory intermediate-term results in about two out of three cases.

CONCLUSION

The frequency of chronic pelvic and perineal pain following suburethral tape placement appears to be underestimated. The diagnostic approach is based on complete clinical examination and infiltration along the tape and any nerves involved. Surgical removal of the tape provides the best intermediate-term analgesic results.