1
|
Smith A, Burton L, Mama S. Surgical Approach to Urethral Diverticulum and Urethrovaginal Fistula With Mesh Erosion. Int Urogynecol J 2024; 35:1327-1329. [PMID: 38733381 PMCID: PMC11245446 DOI: 10.1007/s00192-024-05787-3] [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: 12/17/2023] [Accepted: 03/27/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion. METHODS We present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence. RESULTS The surgery was accomplished without complications. CONCLUSIONS To our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.
Collapse
Affiliation(s)
- Alicia Smith
- Department of Obstetrics and Gynecology, Jefferson Einstein Hospital, Philadelphia, PA, USA.
| | - Lauren Burton
- Department of Obstetrics and Gynecology, Division of Urogynecology, Cooper University Healthcare, Camden, NJ, USA
| | - Saifuddin Mama
- Department of Obstetrics and Gynecology, Division of Urogynecology, Cooper University Healthcare, Camden, NJ, USA
| |
Collapse
|
2
|
Zwierzchowska A, Tomasik P, Horosz E, Barcz E. Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review. J Clin Med 2024; 13:2336. [PMID: 38673609 PMCID: PMC11051119 DOI: 10.3390/jcm13082336] [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: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.
Collapse
Affiliation(s)
| | | | | | - Ewa Barcz
- Department of Gynaecology and Obstetrics, Medical Faculty Collegium Medicum, University of Cardinal Stefan Wyszynski, 01-938 Warsaw, Poland; (A.Z.); (P.T.); (E.H.)
| |
Collapse
|
3
|
Ripa F, Enikeev D, Talyshinskii A, Juliebø-Jones P, Tzelves L, Kallidonis P, Somani B. Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature. Curr Opin Urol 2024; 34:135-144. [PMID: 37933676 DOI: 10.1097/mou.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh. RECENT FINDINGS Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum. SUMMARY Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.
Collapse
Affiliation(s)
- Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department, Rabin Medical Center, Petah Tikva, Israel
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Patrick Juliebø-Jones
- Department of Urology Haukeland and Department of Clinical Medicine, University Hospital, Bergen, Norway
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
4
|
Serafetinidis E, Campos-Juanatey F, Hallscheidt P, Mahmud H, Mayer E, Schouten N, Sharma DM, Waterloos M, Zimmermann K, Kitrey ND. Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma. Eur Urol Focus 2023:S2405-4569(23)00196-7. [PMID: 37968186 DOI: 10.1016/j.euf.2023.08.011] [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: 06/14/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care. OBJECTIVE To present a summary of the 2023 version of the EAU guidelines on the management of urological trauma. EVIDENCE ACQUISITION A systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series. EVIDENCE SYNTHESIS Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance. CONCLUSIONS The guidelines provide an evidence-based approach for the management of urological trauma. PATIENT SUMMARY Trauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.
Collapse
Affiliation(s)
| | | | | | - Husny Mahmud
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Erik Mayer
- Department of Surgery & Cancer, Imperial College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Marjan Waterloos
- Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium
| | - Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel.
| |
Collapse
|
5
|
Zhao S, Fang M, Li Y, Wang F, Li H, Wang L. Fabrication and in vitro investigation of hyperbranched poly-lysine-grafted warp knitted polypropylene sling for potential treatment of stress urinary incontinence. Biomater Sci 2023; 11:6504-6523. [PMID: 37577866 DOI: 10.1039/d3bm00943b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Polypropylene (PP) sling implantation is the most commonly performed procedure for women with stress urinary incontinence (SUI). However, concerns have arisen regarding complications caused by slings, including the common issue of erosion, which can be attributed to various factors such as the body's response and bacterial contamination. To address these concerns, we have developed a rectangular mesh self-locking edge sling with a large pore size and lightweight design. Promising results have been obtained from preliminary in vivo mechanical reliability tests, including uniaxial tensile tests. In comparative in vitro fixed load tensile tests and simulated Tension-free Vaginal Tape (TVT) and Transobturator Vaginal Tape inside-out (TVT-O) technique tests using commercial slings, our sling demonstrated less transverse wrinkling. Both slings achieved an effective porosity of over 45% under the TVT technique. However, the commercial sling experienced a significant reduction in effective porosity during the TVT-O technique, whereas our sling maintained a stable effective porosity with minimal wrinkling. Furthermore, we successfully developed cationic hydration rejection-driven antibacterial-anti-fouling coatings on the surface of our sling by grafting hyperbranched poly-lysine (HBPL) mediated by polynorepinephrine. The HBPL coating imparts a positive charge and hydrophilicity to the sling, resulting in elevated bactericidal activity and reducing protein adhesion. An optimal grafting concentration of 20 mg mL-1 was selected, confirming the stability and biocompatibility of the sling coating. This coating is expected to reduce the likelihood of postoperative erosion. Overall, our research represents significant advancements in improving the safety and performance of PP slings for stress urinary incontinence, potentially leading to a reduction in complications following surgery.
Collapse
Affiliation(s)
- Shuying Zhao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Meiqi Fang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Yan Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Fujun Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Hao Li
- Shanghai Hongyu Medical Technology Co., Ltd, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| |
Collapse
|
6
|
Lam LY, Santos-Cortes JA, O'Rourke TK. A levator ani midurethral support via single vaginal incision technique to treat stress urinary incontinence: A case report. Case Rep Womens Health 2023; 39:e00530. [PMID: 37560023 PMCID: PMC10407623 DOI: 10.1016/j.crwh.2023.e00530] [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: 07/04/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Stress urinary incontinence affects more than one-fourth of adult women. The recommended surgical treatment involves the use of a synthetic mesh sling. Upon unsuccessful treatment using a mesh sling or when patients decline mesh, surgical treatments, including an autologous fascia sling, colposuspension, or bulking injections, are used. After unsuccessful treatment using three mesh slings, an autologous fascia sling, and a midurethral bulking agent, a patient was successfully treated with our modified Kelly plication technique. A 51-year-old woman with recurrent stress urinary incontinence had had three previous mesh midurethral sling exposures with complete mesh removals followed by one autologous fascia sling with severe infection. We initially treated her with a set of urethral bulking injections, which was also unsuccessful. She was successfully treated with our modified Kelly plication technique, which plicates levator ani muscles to support the midurethral instead of plicating the vesicovaginal fascia at the bladder neck. The patient remained continent four years after the performance of this technique and had reported no pelvic pain or dyspareunia. The technique is detailed in this paper. This single vaginal incision native tissue technique may be considered when mesh slings or alternative native tissue procedures are not feasible for patients, as in this case.
Collapse
Affiliation(s)
- Lai-Yet Lam
- Division of Gynecology, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Janice A. Santos-Cortes
- Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Timothy K. O'Rourke
- Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| |
Collapse
|
7
|
Mahfouz W, Eid AA, Elbadry M, Elkhiat A, Moussa A, Assem A. Transobturator Tension-Free Vaginal Flap Operation versus Synthetic Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A Prospective Randomized Study. Urol Int 2023; 107:785-791. [PMID: 37499640 DOI: 10.1159/000529808] [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: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. METHODS This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. RESULTS Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. CONCLUSIONS TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed.
Collapse
Affiliation(s)
- Wally Mahfouz
- Urology department, Alexandria University, Alexandria, Egypt
| | | | | | | | - Ahmed Moussa
- Urology department, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Urology department, Alexandria University, Alexandria, Egypt
| |
Collapse
|
8
|
Uysal D, Güven CM, Akgün S, Sivaslioğlu AA. Long-term efficacy of the single-incision mini-sling procedure using surgeon-tailored mesh. Eur J Obstet Gynecol Reprod Biol 2023; 287:59-62. [PMID: 37295345 DOI: 10.1016/j.ejogrb.2023.06.002] [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: 10/06/2022] [Revised: 04/15/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the long-term efficacy of a surgeon-tailored single-incision mini-sling procedure (SIMS) for the surgical treatment of stress urinary incontinence (SUI) in terms of objective cure rates, quality of life, and cost-effectiveness. STUDY DESIGN This retrospective study included 93 women with pure SUI who underwent surgeon-tailored SIMS. All patients were evaluated with a stress cough test and quality of life questionnaire (Incontinence Impact Questionnaire [IIQ-7]) at 1 month, 6 months, 1 year, and last follow-up visit (4-7 years). Early and late (after 1 month) complication rates and the reoperation rate were also evaluated. RESULTS Mean operative time and follow-up duration were 12 ± 2.5 min and 5.7 years (4-7 years), respectively. Objective cure rates determined by the stress cough test were 83.8%, 94.6%, 93.5%, and 91.3% at 1 month, 6 months, 1 year, and last follow-up, respectively. IIQ-7 scores improved at every visit compared to the preoperative value. There were no cases of hematuria, bladder perforation, or major bleeding requires a blood transfusion. CONCLUSION Our results suggest that the surgeon-tailored SIMS procedure has high efficacy and low complication rates and offers a practical and inexpensive alternative to commercial high-cost SIMS systems.
Collapse
Affiliation(s)
- Dilek Uysal
- Department of Obstetrics and Gynecology, Atatürk Training and Research Hospital, University of Katip Çelebi, Izmir, Turkey
| | - Cenk Mustafa Güven
- Department of Obstetrics and Gynecology, Izmir Private Can Hospital, Izmir, Turkey.
| | - Seda Akgün
- Department of Obstetrics and Gynecology, Atatürk Training and Research Hospital, University of Katip Çelebi, Izmir, Turkey
| | - Ahmet Akın Sivaslioğlu
- Department of Obstetrics and Gynecology, University of Muğla Sıtkı Kocaman, Mugla, Turkey
| |
Collapse
|
9
|
Puzio CL, Edelstein RA. Urethral synthetic mesh erosion with formation of a large bladder and urethral stone: A case report. Case Rep Womens Health 2023; 38:e00502. [PMID: 37082335 PMCID: PMC10111930 DOI: 10.1016/j.crwh.2023.e00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Synthetic urethral support mesh has been used for many years for the treatment of urinary stress incontinence. Late complications such as pain, mesh erosion, and recurrent urinary tract infection have been well described. A 57-year-old patient presented with a primary complaint of worsening lower urinary tract obstruction. She had undergone placement of a pubovaginal tension-free vaginal tape for the treatment of urinary stress incontinence 13 years earlier. A workup revealed a large stone arising from a section of mesh that had eroded into the proximal urethra. The stone extended from the erosion site into the bladder, creating a high-grade obstruction at the bladder neck. It is quite uncommon to see such a large stone in this setting. The long interval between the original surgery and the subsequent presentation of this complication is also unusual. A high index of suspicion is needed to evaluate late urologic complications related to implanted synthetic mesh.
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Lau HH, Davila GW, Chen YY, Sartori MGF, Jármy-Di Bella ZIK, Tsai JM, Liu YM, Su TH. FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence. Int J Gynaecol Obstet 2023; 161:367-385. [PMID: 36786495 DOI: 10.1002/ijgo.14683] [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: 07/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. OBJECTIVES To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. METHODS Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). SELECTION CRITERIA The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. RESULTS The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. CONCLUSIONS Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.
Collapse
Affiliation(s)
- Hui-Hsuan Lau
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - G Willy Davila
- Center for Urogynecology and Pelvic Health, Holy Cross Medical Group, Fort Lauderdale, Florida, USA
| | - Ying-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Marair G F Sartori
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jung-Mei Tsai
- MacKay Medical College, New Taipei City, Taiwan.,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Min Liu
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Tsung-Hsien Su
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | | |
Collapse
|
12
|
Sharifiaghdas F, Mahmoudnejad N, Mohseni M, Montazeri P. Accreditation of an old surgical technique for stress urinary incontinence: long-term outcomes of modified autologous fascial pubovaginal sling. Int Urol Nephrol 2023; 55:277-283. [PMID: 36335537 DOI: 10.1007/s11255-022-03404-0] [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: 09/10/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate long-term outcomes of modified autologous fascial pubovaginal sling (AFPVS) in women with stress urinary incontinence (SUI). METHODS To evaluate long-term outcomes of modified AFPVS, we retrospectively reviewed the medical records of our patients from 2004 to 2015. From 2 decades ago, we have made modifications to classic surgical technique to make it simpler and faster. RESULTS 199 patients were contacted with mean age of 52 years. The mean follow-up period was 107 months. According to Revised Urinary Incontinence Scale (RUIS) questionnaire, overall success rate was 83.9%. In patients with positive history for SUI surgery, success rate was 73% compared to 87% in those without it. Body mass index was negatively associated with cure rate. We did not encounter any major complications and most of the issues were managed conservatively. Recurrence of SUI occurred in 6 patients (3.5%) after initial improvement. CONCLUSION Modified AFPVS is an effective surgical technique for treatment of SUI with high and durable success rate. At the present time with concerns regarding the use of transvaginal synthetic mesh, there is increasing interest and request for modified traditional procedures. It is likely that AFPVS may become more popular in upcoming years.
Collapse
Affiliation(s)
- Farzaneh Sharifiaghdas
- Shahid Labbafi Nejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, 6517953371, Iran
| | - Nastaran Mahmoudnejad
- Shahid Labbafi Nejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, 6517953371, Iran
| | - Maede Mohseni
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Parham Montazeri
- Shahid Labbafi Nejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, 6517953371, Iran
| |
Collapse
|
13
|
Tyushko MI, Korchynska OO, Sozanska MA, Patskan II. TREATMENT OF STRESS-INDUCED URINARY INCONTINENCE BY TVT-O METHOD (CLINICAL CASE). POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:660-664. [PMID: 38207069 DOI: 10.36740/merkur202306113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Stress urinary incontinence (SUI) is one of the most common diseases accompanied by loss of control over the activity of the bladder. Women are more susceptible to this pathology than men due to the peculiarities of the structure of the genitourinary system, as well as due to pregnancy, childbirth, gynecological operations, and age. Incontinence occurs when a woman coughs, sneezes, laughs, lifts weights, runs, etc. It leads to social isolation and significantly reduces the quality of life of patients. The article analyzes the case of a patient who was in the gynecological department of the Uzhhorod City Maternity Hospital of the Uzhhorod City Council and complained of urinary incontinence during coughing, sneezing, laughing, and physical exertion. A full clinical and laboratory examination, physical examination, and consultation with narrow specialists were conducted. According to the research data, a diagnosis of stress urinary incontinence was made. Urethropexy with a synthetic loop (TVT-O operation) was performed using the Gynecare TVT Obturator System Tension-free Support for Incontinence. The complex treatment included antibacterial, antithrombotic and infusion therapy. The effectiveness of the result of surgical treatment was evaluated taking into account subjective and objective criteria for the restoration of anatomical parameters and functional parameters, as well as the patient's quality of life during dynamic follow-up for 2 years. We noted the high efficiency of surgical treatment of stress urinary incontinence using synthetic material.
Collapse
|
14
|
Hernandez-Reynoso AG, Rahman FS, Hedden B, Castelán F, Martínez-Gómez M, Zimmern P, Romero-Ortega MI. Secondary urethral sphincter function of the rabbit pelvic and perineal muscles. Front Neurosci 2023; 17:1111884. [PMID: 36875671 PMCID: PMC9978527 DOI: 10.3389/fnins.2023.1111884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (P ura ) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average P ura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in P ura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average P ura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average P ura (0.26 ± 0.04 mmHg), with a 2-fold increase in average P ura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average P ura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40-60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.
Collapse
Affiliation(s)
- Ana G Hernandez-Reynoso
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Farial S Rahman
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, United States
| | - Brian Hedden
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Francisco Castelán
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlaxcala, Tlaxcala, Mexico.,Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala City, Mexico
| | - Margarita Martínez-Gómez
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlaxcala, Tlaxcala, Mexico.,Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala City, Mexico
| | - Philippe Zimmern
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mario I Romero-Ortega
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, United States
| |
Collapse
|
15
|
Kulaksiz D, Toprak T, Cubuk A, Yilmaz M, Verit A. A modified mid-urethral sling technique for stress urinary incontinence: Three-year results of a prospective randomized trial in comparison with original transobturator tape procedure. Int Urogynecol J 2022:10.1007/s00192-022-05381-5. [PMID: 36214818 DOI: 10.1007/s00192-022-05381-5] [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: 06/22/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence, which causes many social, psychological, and economic problems. Mid-urethral sling (MUS) surgery is popular worldwide for the treatment of SUI. We aimed to define a new modified mid-urethral sling technique (mMUS) in SUI treatment and to compare it with transobturator tape (TOT) surgery in terms of safety and efficiency. METHODS A prospective, randomized study was planned with 126 women suffering from SUI. The patients were randomly divided into two groups, TOT and mMUS. In mMUS, the obturator membrane was not perforated. The objective and subjective symptoms, pain, quality-of-life measures, and side effect profiles were assessed in a 3-year follow-up. The visual analogue scale (VAS) was used for postoperative pain assessment. The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Patient Global Impression of Improvement (PGI-I) were used for cure assessment scales. RESULTS In total, 96 patients completed 3-year follow-up (TOT, n = 49 and mMUS, n = 47). There was no statistical difference between the procedures in terms of cure rates (87.75% and 87.23%, respectively; p = 0.614). Mean VAS scores at 8 and 24 h postoperatively were significantly higher in the TOT group (p < 0.05). There was no significant difference between the groups in VAS scores after 24 h. There was no significant difference between groups in terms of pad test results, ICIQ, or PGI scores at baseline and 36 months after surgery. CONCLUSIONS We showed that the mMUS procedure was as safe and effective as TOT, with less postoperative groin pain and complications.
Collapse
Affiliation(s)
- Deniz Kulaksiz
- Trabzon Faculty of Medicine, Department of Obstetrics and Gynecology, University of Health Sciences, Trabzon, Turkey.
| | - Tuncay Toprak
- Fatih Sultan Mehmet Training and Research Hospital, Department of Urology, University of Health Sciences, Istanbul, Turkey
| | - Alkan Cubuk
- Faculty of Medicine, Department of Urology, Kırklareli University, Kirklareli, Turkey
| | - Mehmet Yilmaz
- Faculty of Medicine, Department of Urology, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Ayhan Verit
- Fatih Sultan Mehmet Training and Research Hospital, Department of Urology, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
16
|
Toia B, Unterberg S, Sihra N, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ. Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women. Int Urogynecol J 2022; 33:2251-2256. [PMID: 33822257 DOI: 10.1007/s00192-021-04774-2] [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: 05/16/2020] [Accepted: 03/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to determine the presentation of and immediate and longer-term outcomes of vaginal surgical excision of urethral extrusion of mid-urethral tape (MUT). METHODS We performed a retrospective analysis of all patients with urethral extrusion of MUT having vaginal surgical excision between 2007 and 2018. The MUT was removed either partially (via vaginal approach) or completely (via combined vaginal and laparoscopic approach). Functional outcomes and any re-interventions are described. RESULTS Thirty-four patients of median age 53 (range 34-82) years were identified. Preoperative symptomatic recurrent/persistent urinary incontinence was present in 29/34(85%) with 24/34(71%) women having recurrent/persistent stress urinary incontinence (SUI) or stress predominant mixed urinary incontinence (s-MUI) on urodynamics. Vaginal surgical excision was performed alone in 33/34(97%) women and in combination with laparoscopic removal of abdominopelvic MUT in 1/34(3%) woman. In the longer term vaginal/urethral pain resolved or improved in all 15/15(100%) patients presenting with this complaint whilst patient reported poor flow resolved in 8/9 (89%) women. Twenty-eight of 34 women (82%) had persistent/recurrent SUI or s-MUI following MUT excision. Twenty-four of 34 women (71%) had further SUI surgery with cure or improvement of SUI in 20/24 (83%) patients. CONCLUSIONS The outcome of vaginal surgical excision of the MUT was cure or improvement of pain in 100% and resolution of poor flow in 89% women. Recurrent/persistent SUI or s-MUI was present in 82% following removal as compared to 71% women prior to removal. Of the 71% of women electing to have further surgery for recurrent/persistent SUI/s-MUI, 83% were dry or improved afterwards.
Collapse
Affiliation(s)
- Bogdan Toia
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK.
| | - Stephen Unterberg
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Neha Sihra
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Jeremy L Ockrim
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Tamsin J Greenwell
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| |
Collapse
|
17
|
Terziotti F, Gregório EP, Averbeck MA, Almeida SHM. Incontinence outcomes in women undergoing retropubic mid-urethral sling: a retrospective cohort study comparing Safyre™ and handmade sling. Int Braz J Urol 2022; 48:649-659. [PMID: 35503703 PMCID: PMC9306358 DOI: 10.1590/s1677-5538.ibju.2021.0646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/26/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up. Methods We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form – ICIQ-UI SF), and patient satisfaction. Results Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups. Conclusions Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.
Collapse
Affiliation(s)
- Fernando Terziotti
- Programa de Pós-Graduação em ciências da saúde da Universidade Estadual de Londrina - UEL, Londrina, PR, Brasil
| | | | | | | |
Collapse
|
18
|
Cope ZS, Francis S, Gupta A, Lenger SM. History of Surgical Treatments for Female Urinary Incontinence. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zebulun S. Cope
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Sean Francis
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Ankita Gupta
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Stacy M. Lenger
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
19
|
Huang X. Case report of vaginal erosion and recurrence of stress urinary incontinence due to shallow placement of tension-free vaginal tape. BMC Urol 2022; 22:67. [PMID: 35459159 PMCID: PMC9027507 DOI: 10.1186/s12894-022-01016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence (SUI). Erosion of the tape into the vaginal is rare. Very few patients present with vaginal tape erosion and recurrence of SUI. CASE PRESENTATION A 49-year-old female patient with stress urinary incontinence was treated with a retropubic suburethral TVT sling. 2 months later, recurrent symptoms of SUI developed. 6 months later, the patient complained of repeated vaginal discharge and foreign body sensation. Body physical examination revealed a 1-cm-long tape extrusion at the left anterior vaginal wall beside the midline. Cystourethroscopy revealed no urethral mesh erosion. Surgical removal of the extrusion tape revealed that the left arm of the tape was in the vaginal mucosa layer rather than between the whole thickness of the vaginal mucosa and urethral. The tape around the urethral was dissected and removed. A new retropubic tape was placed simultaneously. At the 8-months follow-up after surgery, the patient was continent without tape vaginal exposure. CONCLUSIONS Vaginal mesh erosion should be considered in a patient who presents with sustained vaginal discharge after being treated with a suburethral sling. It is important to place the tape between the whole thickness of the vaginal mucosa and the urethral in SUI surgery. A shallow placement of the tape may lead to vaginal tape erosion and recurrence of SUI. These complications can be avoided by following the correct manipulation procedure and referring to the tissue layer anatomy.
Collapse
Affiliation(s)
- Xiao Huang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou City, 310003, Zhejiang Province, People's Republic of China.
| |
Collapse
|
20
|
Hermieu N, Ouzaid I, Aoun R, Xylinas E, Hermieu JF, Schoentgen N. Urethral exposure of mid-urethral sling: diagnosis, management and functional outcomes. Urology 2022; 164:100-105. [PMID: 35065985 DOI: 10.1016/j.urology.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/10/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To identify symptoms leading to urethral mesh exposure diagnosis, describe the surgical management and evaluate post-operative functional and urodynamic outcomes. METHODS Retrospective observational monocentric study of 15 patients treated by mid-urethral sling removal for urethral exposure, between December 2005 and February 2021, in a pelviperineology centre. RESULTS Fifteen patients were included. The mean time to diagnosis of urethral exposure was 43 months. This diagnosis delay was caused by a non-specific symptomatology. Surgical management consisted of partial removal of the eroded mid-urethral sling fragment by vaginal approach in all cases, with low peri-operative morbidity. At three months follow-up, 87% of the patients had stress urinary incontinence versus 54% at two years. 13 patients had a urodynamic assessment after their mid-urethral sling removal, they all had sphincter insufficiency with a urethral closure pressure lower than 30 cm H2O. Nine patients underwent a second urinary incontinence management procedure, leading to 77% of complete remission and 23% of partial improvement. CONCLUSION Clinical presentation of urethral erosion after mid-urethral sling is heterogeneous. Surgical management is complex; after a good preoperative evaluation, a two-step management strategy including minimally invasive mid-urethral sling removal and treatment of recurrent urinary incontinence leads to good results with 77% of patients cured. Sphincter insufficiency is one of the mechanisms that may explain the high rate of stress urinary incontinence after urethral mesh erosion surgery.
Collapse
Affiliation(s)
- Nicolas Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Rana Aoun
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France,.
| | - Evanguelos Xylinas
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Jean-François Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Nadja Schoentgen
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France,.
| |
Collapse
|
21
|
Erdemoglu E, Öztürk V, Turan İ, Erdemoglu E. Vaginally Assisted Laparoscopic Urethrolysis and Mesh Excision after Tension-free Vaginal Tape. J Minim Invasive Gynecol 2021; 28:1975-1977. [PMID: 34224871 DOI: 10.1016/j.jmig.2021.06.024] [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: 04/09/2021] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To present technique of vaginally assisted laparoscopic urethrolysis and mesh excision after tension-free vaginal tape. DESIGN Demonstration video. SETTING Despite the Food and Drug Administration's warning to limit the use of mesh, midurethral sling surgery (MUS) has not significantly decreased, but operations for complications have increased 3 times [1]. Urethral obstruction after MUS has an incidence of 2.7% to 11% [2] that requires resurgery, which ranges from pull-down, mesh excision to urethrolysis and is chosen by the surgeon's experience. Retropubic urethrolysis and mesh excision are reported to be more successful [3]. Urethrolysis can be performed by a retropubic, transvaginal, or suprameatal approach. Transvaginal mesh excision and urethrolysis are not satisfactory in all cases, and it might be difficult to identify the mesh if it is dislocated proximally or buried in dense fibrosis, which may increase urethral/bladder injuries. Although vaginal urethrolysis and mesh removal are usually preferred as the primary approach, there is no randomized controlled trial comparing retropubic and vaginal urethrolysis with/without mesh removal. Gynecologists should master each technique to provide individualized treatment. Laparoscopic urethrolysis has the advantage of the identification of neighboring structures and provides a safer operation (Fig. 1). Combined vaginal and laparoscopic approaches can be used to totally remove the mesh and for difficult surgeries at the junction of the retropubic urethra and the midurethra (Fig. 2). INTERVENTIONS (1) Timing of urethrolysis is controversial. Although urethral loosening or pulling down in the first few days and mesh excision in the first 15 days can be useful, urethrolysis can be chosen for delayed cases with marked fibrosis. Preoperative diagnostic cystoscopy to exclude urethral mesh erosion is essential. Intermittent catheterization until surgery should be done. (2) The technique is described in 5 steps. The arcus tendineus is an important landmark [4] (Fig. 3). CONCLUSION Laparoscopic urethrolysis for urinary obstruction after MUS can be a safe and successful procedure after failed vaginal approach or can be considered as a primary approach in select cases.
Collapse
Affiliation(s)
- Evrim Erdemoglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey (all authors)..
| | - Volkan Öztürk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey (all authors)
| | - İlyas Turan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey (all authors)
| | - Ebru Erdemoglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey (all authors)
| |
Collapse
|
22
|
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.
Collapse
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.
| |
Collapse
|
23
|
Waterloos M, Verla W, Wirtz M, Waterschoot M, Claeys W, Francois P, Lumen N. Female Urethroplasty: Outcomes of Different Techniques in a Single Center. J Clin Med 2021; 10:3950. [PMID: 34501397 PMCID: PMC8432057 DOI: 10.3390/jcm10173950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Female urethral strictures and injuries are relatively uncommon compared to males. A wide range of possible causes and treatment modalities have been described. Lately female urethral reconstruction is gaining attention and is fortunately no longer a neglected topic within the reconstructive urology. As such, we aimed to describe our surgical techniques and outcomes for female urethroplasty from a tertiary center. MATERIALS AND METHODS Records of female patients who underwent a urethroplasty between July 2018 and May 2021 in our tertiary referral center were reviewed. Patients were subdivided in two groups: patients who suffered from a urethral injury and received an early repair urethroplasty, and patients with a true urethral stricture who received a delayed urethroplasty. Preprocedural, surgical and postoperative data were collected and analyzed with descriptive statistics. RESULTS A total of five patients in group 1 and nine patients in group 2 were included. Etiology of the urethral injury in group 1 was iatrogenic in 80% and transitional cell carcinoma of the urethra in 20% of cases. A patency rate of 100% at a follow-up of 30 months was achieved with the different techniques. In group 2 etiology was idiopathic (44%), iatrogenic (44%) and due to external trauma in 12% of cases. Urethroplasty technique consisted of primary repair or dorsal onlay of a buccal mucosal graft. Patency rate was 100% at a median follow-up of 13 months. Three patients suffered from postoperative urinary incontinence, one in group 1 and two in group 2. CONCLUSION Female urethroplasty is a relatively rare entity within reconstructive urethral surgery. This case series of 14 patients demonstrates that with appropriate surgical techniques, a high patency rate with a low complication rate can be achieved. Further prospective studies with standardized diagnostic workup and follow-up should be performed in order to optimize management strategy.
Collapse
Affiliation(s)
- Marjan Waterloos
- AZ Maria Middelares Gent, 9000 Ghent, Belgium
- Ghent University Hospital, 9000 Ghent, Belgium; (W.V.); (M.W.); (M.W.); (W.C.); (N.L.)
| | - Wesley Verla
- Ghent University Hospital, 9000 Ghent, Belgium; (W.V.); (M.W.); (M.W.); (W.C.); (N.L.)
| | - Michel Wirtz
- Ghent University Hospital, 9000 Ghent, Belgium; (W.V.); (M.W.); (M.W.); (W.C.); (N.L.)
| | - Mieke Waterschoot
- Ghent University Hospital, 9000 Ghent, Belgium; (W.V.); (M.W.); (M.W.); (W.C.); (N.L.)
| | - Wietse Claeys
- Ghent University Hospital, 9000 Ghent, Belgium; (W.V.); (M.W.); (M.W.); (W.C.); (N.L.)
| | | | - Nicolaas Lumen
- Ghent University Hospital, 9000 Ghent, Belgium; (W.V.); (M.W.); (M.W.); (W.C.); (N.L.)
| |
Collapse
|
24
|
Lin YH, Lee CK, Chang SD, Chien PC, Hsu YY, Tseng LH. Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26257. [PMID: 34128853 PMCID: PMC8213295 DOI: 10.1097/md.0000000000026257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure. METHODS A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications. RESULTS A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported. CONCLUSIONS Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.
Collapse
Affiliation(s)
- Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Cheng-Kai Lee
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Shuenn-Dyh Chang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Pei-Chun Chien
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Yu-Ying Hsu
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Ling-Hong Tseng
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| |
Collapse
|
25
|
Sarikaya K, Senocak C, Sadioglu FE, Ciftci M, Bozkurt OF. Comparison of Long-Term Outcomes of Transobturator Rectus Fascia Sling and Polypropylene Mesh in Obese Women? J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Cagri Senocak
- Keçiören Training and Research Hospital, Ankara, Turkey
| | | | - Mehmet Ciftci
- Keçiören Training and Research Hospital, Ankara, Turkey
| | | |
Collapse
|
26
|
Schmidt A, Taylor D. Letter to the editor. J Mech Behav Biomed Mater 2021; 126:104548. [PMID: 34030975 DOI: 10.1016/j.jmbbm.2021.104548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Amanda Schmidt
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - David Taylor
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
| |
Collapse
|
27
|
Çubuk A, Şahan A, Özkaptan O, Dinçer E, Karaaslan O, Sarılar Ö, Akça O. Impact of Autologous Transobturator Sling Surgery on Female Sexual Function: A Comparative Study with Mesh Used Mid-Urethral Sling Surgeries. Urol Int 2021; 105:764-770. [PMID: 33951661 DOI: 10.1159/000514415] [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: 10/12/2020] [Accepted: 01/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To avoid mesh-related complications, autologous transobturator-tape (a-TOT) technique is a viable option in stress urinary incontinence (SUI) surgery. The method differs from TOT and retropubic tape (RT) in the usage of autologous tissue. We hypothesized that a-TOT improves female sexual dysfunction (FSD) more than TOT and RT. METHODS This is a retrospective cohort study. Patients who underwent a-TOT, TOT, and RT surgeries were surveyed regarding the cure of SUI, complications, and FSD parameters. The groups were compared according to baseline and postoperative data. RESULTS A-TOT, TOT, and RT groups included 37, 69, and 36 patients, respectively. The median follow-up time was 19 months. The groups were similar in terms of preoperative characteristics. The objective cure, subjective cure, and overall complication rates were comparable among the groups (p > 0.05). A-TOT group had significant improvements in mean female sexual function index (FSFI) scores, TOT group deteriorated, and RT group remained stable (p = 0.001, p = 0.001, and p = 0.226, respectively). The postoperative mean total FSFI scores were 25.73 ± 2.46, 23.17 ± 3.35, and 21.53 ± 2.47 for the a-TOT, TOT, and RT groups, respectively. The a-TOT group had better results than the TOT and RT groups (p < 0.05 and p < 0.05), and besides, the difference between the TOT and RT groups was statistically significant (p < 0.05). According to percentage changes in domain scores following the operations, the a-TOT group had significantly better results in desire, arousal, lubrication, satisfaction, and pain domains than the TOT group (p < 0.05) as well as better desire, arousal, and pain domains (p < 0.05) than the RT group. DISCUSSION/CONCLUSIONS Besides comparable outcomes in SUI treatment, the a-TOT technique provides improvements in female sexual functions while TOT worsens and RT does not change. Favorable outcomes in sexual functions caused by improvements in desire, arousal, satisfaction, and pain domains are observed following the a-TOT technique.
Collapse
Affiliation(s)
- Alkan Çubuk
- Department of Urology, Kartal Dr. Lutfi Kırdar Traning and Research Hospital, Istanbul, Turkey
| | - Ahmet Şahan
- Department of Urology, Kartal Dr. Lutfi Kırdar Traning and Research Hospital, Istanbul, Turkey
| | - Orkunt Özkaptan
- Department of Urology, Kartal Dr. Lutfi Kırdar Traning and Research Hospital, Istanbul, Turkey
| | - Erdinç Dinçer
- Department of Urology, Kartal Dr. Lutfi Kırdar Traning and Research Hospital, Istanbul, Turkey
| | - Onur Karaaslan
- Department of Obstetrics and Gynecology, Van Yuzuncu Yıl University, Van, Turkey
| | - Ömer Sarılar
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Oktay Akça
- Department of Urology, Kartal Dr. Lutfi Kırdar Traning and Research Hospital, Istanbul, Turkey
| |
Collapse
|
28
|
Tong J, Xu W. CT Imaging Characteristics and Influence Factors of Renal Dialysis-Associated Peritoneal Injury. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5591124. [PMID: 33986942 PMCID: PMC8079201 DOI: 10.1155/2021/5591124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
Peritoneal dialysis (PD), as one of the main renal replacement modalities for end-stage renal disease, gets the advantages of better protection of residual renal function and better quality of survival. However, ultrafiltration failure after peritoneal injury is an important reason for patients to withdraw from PD treatment. Peritonitis is a major complication of peritoneal dialysis, which results in an accelerated process of peritoneal injury due to direct damage from acute inflammation and local release of cytokine TGF-β. In this paper, the application of ultrasound to examine the peritoneum revealed a positive correlation between peritoneal thickness and the development of peritonitis. The results of this study also further confirmed the effect of peritonitis on peritoneal thickening. A multifactorial regression analysis also revealed that peritonitis and its severity were independent risk factors for peritoneal thickening and omental structural abnormalities. This paper reported a correlation between mural peritoneal thickness and peritoneal transit function. In this study, patients with high peritoneal transit and high mean transit were found to be more prone to omental structural abnormalities than patients with low mean and low transit and a higher proportion of patients with mural peritoneal thickening, but this did not reach statistical significance, which may be related to the still small number of cases.
Collapse
Affiliation(s)
- Jin Tong
- Department of Nephrology, Zhuji People's Hospital, Zhuji, Zhejiang 311800, China
| | - Wangda Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| |
Collapse
|
29
|
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.
Collapse
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.
| |
Collapse
|
30
|
Marín-Martínez FM, Oñate-Celdrán J, Molina-Hernández O, Artes-Artes M, Bobadilla-Romero ER, García-Porcel VJ, Guzmán-Martínez Valls PL, Andreu-García A, Sánchez-Rodríguez C, García-Escudero D, Suarez-Pineda MC, Valdelvira-Nadal P. Medium-term safety outcomes in patients undergoing tension free vaginal tape obturator for stress urinary incontinence in Murcia, Spain. Historical cohort. ACTA ACUST UNITED AC 2021; 72:43-52. [PMID: 33878813 PMCID: PMC8372762 DOI: 10.18597/rcog.3613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Objective: Describe the medium-term safety of the tension free vaginal tape obturator (TVT-O) procedure in terms of complications, cure and changes in quality of life (QoL) after the surgery. Materials and methods: Descriptive historical cohort that included women over 18 years of age who underwent TVT-O due to objectively proven stress urinary incontinence, urethral hypermobility or mixed urinary incontinence in which the stress component predominated, confirmed on urodynamic testing between July 2013-April 2017, in a reference hospital located in the city of Murcia Spain. Women with previous anti-incontinence surgery, concomitant vaginal surgery and planning pregnancy were excluded. Follow-up was determined for each patient based on the time elapsed between surgery and the time when the research protocol was applied. Complications were stratified according to the modified Clavien-Dindo classification; also we evaluated subjective cure rate, quality of life using the ICIQ-SF score, before and after surgery. Results: The mean age was 52.6 (SD± 10.5) years and 80.1% of patients were at least overweight. The incidence of complications at 12 months was: 8.3% (12/144). We did not detect complications after this period in the followed patients at 24, 36 and 48 months. The subjective cure determined at 12, 24, 36 and 48 months was 62.5% (90/144), 59.09% (55/88), 50.81% (31/61) and 50% (7/14), respectively. There was a significant improvement in quality of life, as determined by the ICQ-SF mean score before and after surgery (13.76[6,34] vs 3.84[5.76]; p<0.05). Conclusions: The TVT-O surgery is a safe therapy associated with a low complication incidence at 12 months, an acceptable subjective cure rate in stress urinary incontinence, and quality-of-life improvement. Classifications of complications related to the insertion of the prosthesis and of those inherent to surgery, such as urinary tract infection, are required.
Collapse
|
31
|
Vasudeva P, Tyagi V, Kumar N, Yadav S, Prasad V, Iyer SG. "Mesh free" autologous transobturator mid urethral sling placement for predominant stress urinary incontinence: A pilot study. Neurourol Urodyn 2020; 40:659-665. [PMID: 33348447 DOI: 10.1002/nau.24599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
AIMS To assess the efficacy and safety of autologous mid-urethral sling (MUS) in women with predominant stress urinary incontinence (SUI). MATERIALS AND METHODS This prospective cohort study included adult women with predominant SUI seen in our urology clinic between January 2018 and March 2019. Patients with: negative cough stress test, history of prior incontinence surgery, urogenital malignancy, pelvic radiation, neurological disease, body mass index more than 40 kg/m2 , the presence of more than Stage I pelvic organ prolapse, active urinary tract infection, maximum flow rate less than 15 ml/sec, postvoid residual urine more than 100 ml, abdominal leak point pressure less than 60 cm of H2 O, and pregnant women were excluded. Eligible patients underwent a transobturator MUS procedure using rectus fascia as a sling. Before the procedure, patients filled the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS) and the Female Sexual Function Index (FSFI) questionnaire. Urinary outcomes were assessed at 3- and 12-months while sexual outcomes were assessed at 12-months. RESULTS Thirty patients with median age of 44.5 years were included. All patients had a negative cough stress test during follow up. A significant improvement was noted in the ICIQ-FLUTS scale, bother scale, filling and incontinence subscales at 3 and 12 month follow-up. A significant improvement was also noted in the FSFI full scale score and FSFI domains of mean sexual desire, arousal and lubrication at 12 months follow-up. Two patients developed voiding dysfunction requiring urethral dilatation. CONCLUSION Autologous transobturator MUS surgery appears to be safe and efficacious in the short term. More research is needed to clarify its role in the surgical management of SUI in women.
Collapse
Affiliation(s)
- Pawan Vasudeva
- Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India
| | - Vijay Tyagi
- Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India
| | - Niraj Kumar
- Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India
| | - Siddharth Yadav
- Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India
| | - Vishnu Prasad
- Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India
| | - Saumya G Iyer
- Department of Urology and Renal transplant, VM Medical College and Safdarjang Hospital, New Delhi, India
| |
Collapse
|
32
|
Schmidt A, Taylor D. Erosion of soft tissue by polypropylene mesh products. J Mech Behav Biomed Mater 2020; 115:104281. [PMID: 33348215 DOI: 10.1016/j.jmbbm.2020.104281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023]
Abstract
Surgical mesh products made from polypropylene (PP) have been extensively used in the treatment of stress urinary incontinence, pelvic organ prolapse and other conditions. Since the onset of the use of such implants, major complications have been reported. Mesh erosion, where neighbouring tissues are worn from the rubbing of mesh, occurs in a significant number of cases. However, there is still a lack in literature exploring the mechanics of this phenomenon. In this study, a purpose-built apparatus was used to generate erosion in soft tissue (porcine muscle) through the application of a force and a reciprocating action. Four different commercial products were tested, all made from knitted PP fibres: Monarc™ Gynecare™ and Obtryx™ slings and Sutulene™ mesh sheet material. A PP suture and three PP sheets with different edge roughness were also tested. Large differences were found in the erosion rates. Significantly, we found that meshes in which the edge had been formed using heat to cause partial melting gave much higher rates of erosion than mechanically cut edges. Heat-formed edges tended to retain their shape whilst mechanically cut edges degraded by unravelling. Several features of the mesh edge appear to be significant, including roughness, flexibility and the tendency to degrade. Constant load (non-reciprocating) tests were also carried out, revealing that creep can also cause erosion. These findings have significance for the design of surgical mesh products to minimise their adverse effects.
Collapse
Affiliation(s)
- Amanda Schmidt
- Trinity Centre for Bioengineering, Trinity College Dublin, The University of Dublin, Ireland
| | - David Taylor
- Trinity Centre for Bioengineering, Trinity College Dublin, The University of Dublin, Ireland.
| |
Collapse
|
33
|
Arruda GJFD, Bonfitto M, Arruda Neto JFD, Spessoto LCF, Arruda JGFD, Fácio FN. Embolization in Patient with Hypovolemic Shock after Transobturator Sling Procedure. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:769-771. [PMID: 33254273 PMCID: PMC10309248 DOI: 10.1055/s-0040-1718435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The placement of a suburethral sling is standard treatment for stress urinary incontinence. The transobturator technique (TOT) emerged as an alternative to minimize the risks of the blind insertion of needles, leading to a lower rate of perforation complications compared with the retropubic approach. We present a case of injury to a branch of the left obturator artery following the placement of a urethral sling using TOT, followed by intense bleeding and hemodynamic instability, which was treated with embolization.
Collapse
Affiliation(s)
| | - Miguel Bonfitto
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | | | | | | |
Collapse
|
34
|
Jones SL, Guo Y, Nguyen L. Case - Resolution of urethral mesh perforation after sling: The migrating mesh. Can Urol Assoc J 2020; 15:E184-E186. [PMID: 32807278 DOI: 10.5489/cuaj.6645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sara Luisa Jones
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | - Yanbo Guo
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Laura Nguyen
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
35
|
Hermieu N, Schoentgen N, Aoun R, Neveu P, Grassano Y, Egrot C, Kassem A, Xylinas E, Ouzaid I, Hermieu JF. [Surgical management of suburethral sling complications and functional outcomes]. Prog Urol 2020; 30:402-410. [PMID: 32409239 DOI: 10.1016/j.purol.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify various clinical presentation leading to the diagnosis of mid-urethral sling (MUS) complications and to analyze the functional outcomes after surgical management of these complications. METHOD Retrospective observational monocentric study of all patients treated by MUS section or removal, between December 2005 and October 2019, in a pelviperineology centre. RESULTS During this study, 96 patients were included. MUS complications surgically managed were vaginal mesh exposure (48 %), urethral mesh exposure (17 %), bladder mesh exposure (10 %); dysuria (30 %), pain (6 %), and infection (3 %). The mean time to diagnosis was 2 years. This diagnosis delay was caused by a non-specific and heterogeneous symptomatology. Surgical management consisted in MUS partial removal (79 %) and MUS simple section (21 %) with low perioperative morbidity. At three months follow-up, 36 patients (53 %) had stress urinary incontinence (SUI), including 13 (19 %) de novo (meaning no SUI before MUS section/removal) and 19 (28 %) had overactive bladder, including 9 (13 %) de novo. Half of the patients with SUI after MUS section/removal were able to be treated by a second MUS with a success rate of 83 % at 3 years. CONCLUSION Clinical presentation of MUS complications is heterogeneous. Surgical treatment was associated with low morbidity in our study. Post-operatively, half of the patients had SUI and a second MUS was a relevant treatment option after proper evaluation. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- N Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - N Schoentgen
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - R Aoun
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Neveu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - Y Grassano
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Egrot
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Kassem
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Xylinas
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - I Ouzaid
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - J F Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| |
Collapse
|
36
|
Huang X, Jiang H, Xie L. Case report of sigmoid colon perforation and colocutaneous fistula due to retropubic midurethral sling placement for stress urinary incontinence. BMC Urol 2020; 20:33. [PMID: 32197605 PMCID: PMC7082911 DOI: 10.1186/s12894-020-00600-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sigmoid bowel perforation is a very rare and serious complication of the retropubic tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. The complication can be avoided with the use of the correct manipulation technique. CASE PRESENTATION A 75-year-old female patient underwent a retropubic TVT procedure in the local hospital for the treatment of stress urinary incontinence. The procedure was smooth. Two weeks after surgery, the patient began to complain of fever and bloody, purulent discharge from the left suprapubic skin wound. During a 4-month period after surgery, she was admitted to the local hospital 4 times for similar infection symptoms. The infections were temporarily controlled with antibiotic administration. The reason for the refractory infection of the left suprapubic skin wound was not identified until a foreign TVT mesh was found in the sigmoid colon via a colonoscopy. We diagnosed that the TVT mesh caused a sigmoid colon perforation that led to colocutaneous fistula. An exploratory laparotomy revealed that the TVT tape perforated into and out of the sigmoid colon. An 8-cm long left part of mesh was removed. Two ruptures of sigmoid colon were mended without the need for bowel resection. At the 4-years follow-up after laparotomy, the patient was doing well and still continent. CONCLUSIONS Urologists and gynecologists should be aware of the possibility of colon bowel injury in SUI patients with prior sling surgeries. Patient having recurrent suprapubic cutaneous infection may have high degree of suspicion of colon injury after TVT sling. The passage of the retropubic space procedure should be slow and always along the pubic bone according to the anatomy.
Collapse
Affiliation(s)
- Xiao Huang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 QingChun Road, Hangzhou, 310003, Zhejiang Province, PR China.
| | - Hai Jiang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 QingChun Road, Hangzhou, 310003, Zhejiang Province, PR China
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 QingChun Road, Hangzhou, 310003, Zhejiang Province, PR China
| |
Collapse
|
37
|
Tepe NB, Bayrak Ö, Şen H, Uğur MG, Erturhan S, Seçkiner İ. Comparison of the efficiency of partial versus subtotal mesh removal on urogenital distress and sexual functions after stress urinary incontinence surgery. Turk J Urol 2019; 46:140-145. [PMID: 31657696 DOI: 10.5152/tud.2019.19113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. MATERIAL AND METHODS Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. RESULTS Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). CONCLUSION In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.
Collapse
Affiliation(s)
- Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ömer Bayrak
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Haluk Şen
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Department of Obstetrics and Gynecology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Sakıp Erturhan
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - İlker Seçkiner
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| |
Collapse
|
38
|
Emami M, Momtazan A, Maghsoudi R, Ameli M, Kashi A, Amirpoor M, Karimi S. Transobturator tape and mini-sling methods in stress urinary incontinence: Results of a randomized clinical trial. Urologia 2019; 86:152-155. [DOI: 10.1177/0391560319845255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Stress urinary incontinence is one of the most common types of incontinence in premenopausal women, accounting for almost 50% of such cases. Mid-urethral slings are currently the most widely used surgical method for stress urinary incontinence. This study aimed at comparing the efficacy, complications, urodynamic changes and the sexual function status between mini-sling surgery and transobturator tape to help us select the best method in such patients. Method: In this randomized controlled trial, 80 cases were studied and randomly assigned to either the mini-sling or transobturator tape group (n = 40). A full medical history was taken and the Q.tip and cough tests were performed for each patient to record their urinary incontinence and hypermobility. Abdominal and pelvic ultrasound study was requested by specifying PVR and urodynamic testing. The International Consultation on Incontinence Modular Questionnaire-6 was filled by the patients and the Female Sexual Functioning Index questionnaire by the physician. The patients were followed-up 8 weeks after discharge by urodynamic tests, ultrasound study, and the International Consultation on Incontinence Modular Questionnaire test. Results: The mean age, body mass index, and parity were not significantly different between the two groups. The mean surgical time, amount of bleeding, hospitalization period, and pain index were significantly less in the mini-sling group. The International Consultation on Incontinence Modular Questionnaire and Female Sexual Functioning Index indices before and after surgery showed no significant difference between the two groups. The difference in urodynamic test parameters was also insignificant. Conclusion: In the mini-sling method which is a less invasive method compared to transobturator tape, the intraoperative bleeding, surgical time, hospitalization period, pain, and surgical complications were far less while its efficacy was similar to transobturator tape; therefore, it is recommended in treating stress urinary incontinence among women.
Collapse
Affiliation(s)
- Maryam Emami
- Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mojtaba Ameli
- Gonabad University of Medical Sciences, Gonabad, Iran
| | - Amirhosein Kashi
- Shahid Labbafinejad Hospital, Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | | | - Sara Karimi
- Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
39
|
Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial. Wideochir Inne Tech Maloinwazyjne 2019; 15:18-29. [PMID: 32117482 PMCID: PMC7020724 DOI: 10.5114/wiitm.2019.84702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/16/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction The midurethral sling has become the current standard for the treatment of female stress urinary incontinence. Aim To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures. Material and methods The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6- and 12-month follow-up. Results A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13–0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16–0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97–6.3; OR = 2.3, 95% CI: 0.95–5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality. Conclusions TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.
Collapse
|
40
|
Management of Mesh-Related Pelvic Inflammation. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|