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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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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 2021; 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] [MESH Headings] [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 CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
- General Surgery Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Anna Pereda‐Núñez
- Pelvic Floor Unit, Department of Obstetrics and GynecologyHospital General de GranollersBarcelonaSpain
| | | | - Manuel Urbaneja
- Department of GynecologyHospital Virgen del RocíoSevillaSpain
| | | | - Narcís Camps‐Lloveras
- Functional Urology and Urodynamics Unit, Department of Urology, Hospital Universitari de BellvitgeUniversitat de BarcelonaBarcelonaSpain
| | - Àngela Pérez‐Plantado
- Department of Gynecology, Hospital de MataróConsorci Sanitari del MaresmeBarcelonaSpain
| | | | | | - Nuria Rodríguez‐Mias
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Núria Sarasa‐Castelló
- Pelvic Floor Unit, Department of Obstetrics and GynecologyHospital General de GranollersBarcelonaSpain
| | - Marta Palau
- Department of GynecologyHospital Virgen del RocíoSevillaSpain
| | - Anabel Montero‐Armengol
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Sabina Salicrú
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Antonio Gil‐Moreno
- Department of Gynecology, Hospital Universitari Vall d'HebronVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
- Biomedical Research Group in Gynecology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBERONC)Instituto de Salud Carlos IIIMadridSpain
| | - Jose L. Poza
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
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Akdemir Y, Dincer F, Buyukuysal C, Ozmen U, Harma M, Harma MI. Comparison of outcomes of Burch colposuspension and transobturator tape and single incision needleless procedures (DynaMesh ®-SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy. Int Urol Nephrol 2020; 52:1665-1673. [PMID: 32594287 DOI: 10.1007/s11255-020-02549-0] [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: 05/15/2020] [Accepted: 06/18/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse. The purpose of this study was to evaluate efficacies of Burch colposuspension, transobturator tape (TOT), and single-incision needleless (DynaMesh®-SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. METHODS We performed this retrospective cohort study that comprising 122 patients who either underwent Burch colposuspension (n:43), TOT (n:40), or SIS (n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed cure rates, and surgical success rates of SUI surgery, quality of life, and symptom severity by IIQ-7, UDI-6, SSI, SSQ-8, OAB-V8, and PGI-I scale scores. The primary outcome was surgical success, whereas secondary outcomes included complications and patient-reported outcomes in the quality of life. RESULTS We found that surgical success rates were higher in Burch group than SIS group and higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5%, p = 0.003). The quality of life was lower in SIS group than in Burch group. CONCLUSIONS Both Burch and TOT are effective procedures in patients with SUI who require additional pelvic surgeries. Although surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further studies with SIS are needed to clarify these observations.
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Affiliation(s)
- Yesim Akdemir
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey.
| | - Fadime Dincer
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
| | - Cagatay Buyukuysal
- Department of of Biostatistics, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ulku Ozmen
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
| | - Muge Harma
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
| | - Mehmet Ibrahim Harma
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
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Callewaert G, Housmans S, Cattani L, Pacquée S, D'Hoore A, Wyndaele J, Van der Aa F, Deprest J. Medium-term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: A matched control study. Neurourol Urodyn 2019; 38:1874-1882. [PMID: 31290173 DOI: 10.1002/nau.24083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022]
Abstract
AIM To compare 2-year outcomes of laparoscopic sacrocolpopexy (LSCP) either with polyvinylidene fluoride (PVDF) or hybrid polypropylene containing a resorbable polyglecaprone (PP+ PG) mesh. MATERIALS AND METHODS Retrospective audit on 105 consecutive patients undergoing LSCP a with PVDF-mesh (DynaMesh, FEG Textiltechniken), matched by prolapse stage and cervicopexy or vault suspension to 105 controls undergoing LSCP with a hybrid PP + PG-mesh (Ultrapro, Ethicon). Patients are part of an ongoing prospective study. The primary outcome measure was the Patient Global Impression of Change score (PGIC), the coprimary variable was failure rate at the vault (≤1 cm). Other outcomes were intraoperative and postoperative complications within 3 months categorized by the Clavien-Dindo classification, reinterventions, graft-related complications (GRCs) and functional outcomes. All assessments were performed by an independent assessor. Data are reported as median (interquartile range) number and percent as appropriate, the Mann-Whitney U, χ2 , or Fisher exact were used for comparison. RESULTS Patient satisfaction in the PVDF group, as measured with the PGIC, was high (90.9% PGIC, ≥4) as well as was the anatomical success (97.3%) at a follow-up of 26 months. These outcomes were comparable to those of PP + PG-patients (84.8% PGIC, ≥4; 94.9% anatomical success). There were five patients (2.4%) with Dindo-III or higher complications and three patients had GRCs (1.5%), without differences between mesh type. Level-II posterior defects (Bp ≥ -1) were less likely in PVDF patients (34.1% vs 50% for PP + PG-patients; P = .003). Women in the PVDF group also were less bothered by prolapse (7.5% vs 26.4%; P = .001), yet they complained more of constipation (15.0% vs 9.0%; P = .01). CONCLUSION There were no differences in patient satisfaction and anatomical outcomes after LSCP either with PVDF or PP + PG mesh.
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Affiliation(s)
- Geertje Callewaert
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susanne Housmans
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Laura Cattani
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stefaan Pacquée
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - André D'Hoore
- Pelvic Floor Unit, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.,Oncology and Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Wyndaele
- Pelvic Floor Unit, Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Pelvic Floor Unit, Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Deprest
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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