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Rudroff C, Madukkakuzhy J, Hernandez AV, Otten J, Ulrici C, Karapanos L, Ludwig S. Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study. BMC Surg 2024; 24:185. [PMID: 38877450 PMCID: PMC11177501 DOI: 10.1186/s12893-024-02474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. AIM OF THE STUDY: This retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP. METHODS The study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM). RESULTS Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%). CONCLUSIONS The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study's retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials. TRIAL REGISTRATION Retrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.
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Affiliation(s)
- Claudia Rudroff
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany.
| | - Joshy Madukkakuzhy
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
| | - Alberto Vega Hernandez
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of General, Visceral and Minimally Invasive Surgery, Park-Klinik Weissensee Berlin, Berlin, Germany
| | - Jakob Otten
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Christoph Ulrici
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Clinic for General and Visceral Surgery, Evangelisches Klinikum Köln Weyertal GmbH, Academic Hospital of the University of Cologne, Weyertal 76, Cologne, 50931, Germany
- Department of General and Visceral Surgery, St.Josef Hospital Bonn-Beuel, GFO Kliniken Bonn, Bonn, Germany
| | - Leonidas Karapanos
- Department of Urology, Division of Neurourology, University Hospital of Cologne and Medical Faculty Cologne, 50931, Cologne, Germany
- Department of Urology, Municipal Hospital of Leverkusen, Leverkusen, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University Hospital of Cologne and Medical Faculty Cologne, 50931, Cologne, Germany
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Karalis T, Tsiapakidou S, Grimbizis GF, Mikos T. Surgical results in POP/UI surgery after using PVDF compared to other materials. A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 284:110-119. [PMID: 36966589 DOI: 10.1016/j.ejogrb.2023.03.018] [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: 06/08/2022] [Revised: 02/01/2023] [Accepted: 03/18/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES Synthetic materials have been used for the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). During the last 25 years, these materials were composed mostly of polypropylene (PP), whereas recently the use of polyvinylidene difluoride (PVDF) is of increasing interest due to its characteristics. This study aimed to compare the results after SUI/POP surgery using PVDF versus PP materials by synthesizing the data of relevant existing literature. STUDY DESIGN This systematic review and meta-analysis included clinical trials, case-control studies, or cohort studies written in the English language. The search strategy included the electronic databases MEDLINE, EMBASE, and Cochrane, and grey literature (congresses IUGA, EUGA, AUGS, FIGO). All studies have to provide numeric data or odds ratios (OR) of developing a specific outcome in surgeries with PVDF compared with outcomes of other used materials. No restrictions of race or ethnicity were applied, nor chronological restrictions. Exclusion criteria were studies that included patients with cognitive impairment, dementia, stroke, or central nervous system trauma. All studies were screened by two reviewers, initially by title and abstract, and afterward by full text. Disagreements were resolved through mutual consent. All studies were assessed for their quality and bias risk. Data were extracted using a data extraction form formulated in a Microsoft Excel spreadsheet. Our results were divided into studies dealing only with SUI patients, studies dealing only with POP patients, and cumulative analysis of variables expressed in both SUI and POP surgery. The primary outcomes were the rates of post-operative recurrence, mesh erosion, and postoperative pain after surgery with PVDF compared to PP. The secondary outcomes were post-operative sexual dissatisfaction, overall satisfaction rates, hematoma, urinary tract infection, de novo urge incontinence, and reoperation rate. RESULTS No differences in the post-operative rates of SUI/POP recurrence, mesh erosion, and pain were found after surgery with PVDF vs surgery with PP. Patients after SUI surgery with PVDF tapes had statistically significant lower rates of de-novo urgency compared to the PP group [OR = 0.38 (0.18, 0.88), p = 0.01]; patients after POP surgery with PVDF materials had statistically significant lower rates of de-novo sexual dysfunction compared to the PP group [OR = 0.12 (0.03, 0.46), p = 0.002]. CONCLUSIONS This study provided evidence that the use of PVDF in SUI/POP surgeries could be a valid alternative to PP. However our results are limited by uncertainty due to the overall low quality of the existent data. Further research and validation would contribute to better surgical techniques.
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Affiliation(s)
- Tilemachos Karalis
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Tsiapakidou
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigoris F Grimbizis
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Mikos
- 1(st) Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Sebastian L, Alina J, Fabinshy T, Dominik R, Axel S, Jens H, Kilian W, Claudia R, Leonidas K, Julia R, Nadja T, Christian E. AbsorbaTack ™ vs. ProTack ™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2023; 307:863-871. [PMID: 36404354 PMCID: PMC9984508 DOI: 10.1007/s00404-022-06827-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. METHODS A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. RESULTS There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. CONCLUSION The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.
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Affiliation(s)
- Ludwig Sebastian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.
| | - Jansen Alina
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Thangarajah Fabinshy
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Ratiu Dominik
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Sauerwald Axel
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Hachenberg Jens
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wegmann Kilian
- Department for Trauma, Hand and Elbow Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rudroff Claudia
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Karapanos Leonidas
- Department of Urology, Uro-Oncology, Faculty of Medicine and University Hospital Cologne, Robot- Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany
| | - Radosa Julia
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Trageser Nadja
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Eichler Christian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.,Breast Cancer Center, St. Franziskus-Hospital Münster, 48145, Münster, Germany
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Page AS, Page G, Deprest J. Cervicosacropexy or vaginosacropexy for urinary incontinence and apical prolapse: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 279:60-71. [DOI: 10.1016/j.ejogrb.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
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Jansen AK, Ludwig S, Malter W, Sauerwald A, Hachenberg J, Pahmeyer C, Wegmann K, Rudroff C, Karapanos L, Radosa J, Trageser N, Eichler C. Tacks vs. sutures: a biomechanical analysis of sacral bony fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2021; 305:631-639. [PMID: 34842976 PMCID: PMC8918131 DOI: 10.1007/s00404-021-06343-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 12/01/2022]
Abstract
Purpose There is a novel surgical procedure, called cervicosacropexy (CESA) and vaginosacropexy (VASA) to treat pelvic organ prolapse and a concomitant urgency and mixed urinary incontinence. As there is little experience with the tapes so far and literature is scanty, the aim of this study was to investigate biomechanical properties for the fixation of the PVDF-tapes with three different fixation methods in context of apical fixations. Methods Evaluation was performed on porcine, fresh cadaver sacral spines. A total of 40 trials, divided into 4 subgroups, was performed on the anterior longitudinal ligament. Recorded biomechanical properties were displacement at failure, maximum load and stiffness in terms of the primary endpoints. The failure mode was a secondary endpoint. Group 4 was a reference group to compare single sutures on porcine tissue with those on human tissue. Biomechanical parameters for single sutures on the human anterior longitudinal ligament were evaluated in a previous work by Hachenberg et al. Results The maximum load for group 1 (two single sutures) was 65 ± 12 N, for group 2 (three titanium tacks arranged in a row) it was 25 ± 10 N and for group 3 (three titanium tacks arranged in a triangle) it was 38 ± 12 N. There was a significant difference between all three groups. The most common failure mode was a “mesh failure” in 9/10 trials for groups 1–3. Conclusion The PVDF-tape fixation with two single sutures endures 2.6 times more load than titanium tacks arranged in a row and 1.7 times more load than titanium tacks arranged in a triangle. The presacral fixation with titanium tacks reduced surgical time compared to the fixation with sutures, nevertheless sutures represent the significantly stronger and cheaper fixation method.
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Affiliation(s)
- Alina Katharina Jansen
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany.
| | - Sebastian Ludwig
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Axel Sauerwald
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Jens Hachenberg
- Department of Gynacology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Caroline Pahmeyer
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital Cologne, Department for Trauma, Hand and Elbow Surgery, University of Cologne, Cologne, Germany
| | - Claudia Rudroff
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Leonidas Karapanos
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Radosa
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Nadja Trageser
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50931, Cologne, Germany
- Breast Cancer Center, St. Franziskus- Hospital Münster, 48145, Münster, Germany
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Current Role of Hysterectomy in Pelvic Floor Surgery: Time for Reappraisal? A Review of Current Literature and Expert Discussion. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9934486. [PMID: 34307675 PMCID: PMC8279866 DOI: 10.1155/2021/9934486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022]
Abstract
Since hysterectomy could be performed with low risk, it has been part of the standard of surgical prolapse therapy for decades. This has not been scrutinized for a long time. In this review, we describe the development of this issue in recent years. The current literature suggests that hysterectomy requires its own indication. The article describes the various options for a uterine-preserving surgical technique and the available data.
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Naumann G. Quo Vadis Urogynecology 2020 - Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse. Geburtshilfe Frauenheilkd 2021; 81:183-190. [PMID: 33574622 PMCID: PMC7870286 DOI: 10.1055/a-1302-7803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/01/2020] [Indexed: 12/15/2022] Open
Abstract
The current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patient's state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.
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Affiliation(s)
- Gert Naumann
- Frauenklinik, Helios Klinikum Erfurt, Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Noé GK, Schiermeier S, Papathemelis T, Fuellers U, Khudyakov A, Altmann HH, Borowski S, Morawski PP, Gantert M, De Vree B, Tkacz Z, Ugarteburu RG, Anapolski M. Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair. J Clin Med 2021; 10:jcm10020217. [PMID: 33435323 PMCID: PMC7827325 DOI: 10.3390/jcm10020217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.
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Affiliation(s)
- Günter K. Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Rheinlandclinics Dormagen, 41540 Dormagen, Germany;
- Correspondence:
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, 258452 Witten, Germany;
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, St. Marien Hospital Amberg, 92224 Amberg, Germany;
| | - Ulrich Fuellers
- Private Department of Surgical Gynecology, Krefeld (GTK) Germany, 47800 Krefeld, Germany; (U.F.); (A.K.)
| | - Alexander Khudyakov
- Private Department of Surgical Gynecology, Krefeld (GTK) Germany, 47800 Krefeld, Germany; (U.F.); (A.K.)
| | - Harald-Hans Altmann
- Department of Obstetrics and Gynecology, Regiomed Clinics Coburg, 96450 Coburg, Germany;
| | - Stefan Borowski
- Department of Obstetrics and Gynecology, Clinic Links der Weser, 28277 Bremen, Germany;
| | - Pawel P. Morawski
- Department of Obstetrics and Gynecology, Helios Clinic Bad Sarow, 15526 Bad Saarow, Germany;
| | - Markus Gantert
- Department of Obstetrics and Gynecology, St. Franziskus Hospital Ahlen, 59227 Ahlen, Germany;
| | - Bart De Vree
- Department of Obstetrics and Gynecology, ZNA Middelheim Antwerp, 2020 Antwerpen, Belgium;
| | - Zbigniew Tkacz
- Department of Obstetrics and Gynecology, NHS Tayside Dundee, Dundee DD1 9SY, UK;
| | - Rodrigo Gil Ugarteburu
- Department of Obstetrics and Gynecology, University Hospital de Cabueñes, 33394 Gijon, Spain;
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Rheinlandclinics Dormagen, 41540 Dormagen, Germany;
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Sabadell J, Pereda-Núñez A, Ojeda-de-Los-Santos F, Urbaneja M, González-García C, Camps-Lloveras N, Pérez-Plantado À, Canet-Rodríguez J, Pérez-Espejo MP, Rodríguez-Mias N, Sarasa-Castelló N, Palau M, Montero-Armengol A, Salicrú S, Gil-Moreno A, Poza JL. Polypropylene and polyvinylidene fluoride transobturator slings for the treatment of female stress urinary incontinence: 1-Year outcomes from a multicentre randomized trial. Neurourol Urodyn 2020; 40:475-482. [PMID: 33259073 PMCID: PMC7839450 DOI: 10.1002/nau.24586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/02/2020] [Accepted: 11/15/2020] [Indexed: 11/06/2022]
Abstract
AIMS To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI). METHODS This is a multicentre randomized trial. Women with SUI or stress-predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1-year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models. RESULTS From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p = .138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15-0.80). We found no statistical differences in complications rates, although a higher incidence of long-term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events. CONCLUSION PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles.
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Affiliation(s)
- Jordi Sabadell
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,General Surgery Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Pereda-Núñez
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Hospital General de Granollers, Barcelona, Spain
| | | | - Manuel Urbaneja
- Department of Gynecology, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Narcís Camps-Lloveras
- Functional Urology and Urodynamics Unit, Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Àngela Pérez-Plantado
- Department of Gynecology, Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain
| | | | | | - Nuria Rodríguez-Mias
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Sarasa-Castelló
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Hospital General de Granollers, Barcelona, Spain
| | - Marta Palau
- Department of Gynecology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Anabel Montero-Armengol
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabina Salicrú
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Biomedical Research Group in Gynecology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose L Poza
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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