1
|
Chiang FC, Sun R, Chang YJ, Li YI, Sun MJ. Comparison of Clinical Efficacy and Urodynamic Changes Using Single-incision Slings (MiniArc ® vs. Solyx™) for the Treatment of Female Stress Urinary Incontinence. Gynecol Minim Invasive Ther 2021; 10:235-242. [PMID: 34909381 PMCID: PMC8613486 DOI: 10.4103/gmit.gmit_102_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/15/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To compare the clinical efficacy and urodynamic parameter changes between the MiniArc and the Solyx sling for the treatment of female urodynamic stress incontinence (USI). Materials and Methods: One-hundred and thirty (MiniArc n = 79, BS-Solyx n = 51) patients were included in this study. Cough stress test (ST), pad test (PT), Incontinence Impact short form Questionnaire (IIQ-7), Urogenital Distress Inventory six-item questionnaire (UDI-6), Sexual Questionnaire-Short Form (PIS-Q), and urodynamic parametric changes were assessed to determine objective and subjective outcomes following the procedure. Objective cure was defined as negative ST and PT <2 g and subjective cure was defined as “No” to the answer of UDI-6 Question #3. Predictors of surgical failure were also determined. Results: All Solyx users, as opposed to 91.1% of MiniArc patients, obtained objective cure at postoperative 3 months (P = 0.042). No significant difference in subjective cure rates (93.7% vs. 90.2% at 3-months (P = 0.513); 89.9% vs. 80.4% at 1 year for Solyx and MiniArc patients, respectively (P = 0.126)) and improvement scores in UDI-6 and IIQ-7 were observed. The Solyx group incurred more de novo urgency (17.6% vs. 6.3% at 3 months (P = 0.042); 23.5% vs. 7.6% at 1 year (P = 0.01)). Both procedures yielded significant decrements in maximal urethral closure pressure (P < 0.001) and average flow rate (P = 0.015). The preoperative PT and sling type were strong predictors of surgical failure, where the Solyx tape reported lower odds (odds ratio = 0.174, P = 0.02) compared to the MiniArc sling. Conclusion: Single-incision mini-slings are safe and effective treatment for female USI. The Solyx SIS demonstrated superiority over the MiniArc in this study based on its higher objective cure rate and lower risk for surgical failure.
Collapse
Affiliation(s)
- Fook Chin Chiang
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Changhua Christian Hospital, Changhua, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Cheng Ching Hospital, Taichung, Taiwan
| | - Ryan Sun
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, Canada
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Ing Li
- Center for Urinary Incontinence and Voiding Dysfunction, Changhua Christian Hospital, Changhua, Taiwan
| | - Mou-Jong Sun
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Changhua Christian Hospital, Changhua, Taichung, Taiwan.,Center for Urinary Incontinence and Voiding Dysfunction, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|
2
|
Kilinc MF, Yildiz Y, Hascicek AM, Doluoglu OG, Tokat E. Long-term postoperative follow-up results of transobturator autologous rectus fascial sling versus transobturator tension-free vaginal tapes for female stress urinary incontinence: Randomized controlled clinical trial. Neurourol Urodyn 2021; 41:281-289. [PMID: 34618364 DOI: 10.1002/nau.24813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the outcomes of a new surgical technique for the treatment of stress urinary incontinence (SUI). METHODS This randomized study included 132 index patients from January 2017 to May 2021, 60 applied with autologous facia and 60 with transobturator tension-free vaginal tape (TVT-O). The primary endpoint was dryness (negative stress test and 0 pad use per day) and this was assessed at 3, 6, 12, and 24 months. The secondary endpoints were the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the urinary incontinence quality of life (QoL) at 3, 6, 12, and 24 months. RESULTS The dryness rate at 24 months was 92.4% (49/53) for patients with transobturator autologous rectus fascial sling (TO-AFS) and 94.6% (53/56) for those with TVT-O (p = 0.47). No difference was determined between the TO-AFS and TVT-O groups in respect of the ICIQ-SF and QoL scores at 2 years postoperatively (p = 0.87). There were five postoperative complications in the TO-AFS group (one urinary retention, one hematoma at suprapubic incision line, and three intermittent groin pains) and four in the TVT-O group (four persistent groin pain) (p = 0.98). CONCLUSIONS The objective cure rates of the 24-month outcomes of TO-AFS indicate that this novel surgical technique seems to be a highly effective, safe, and feasible procedure for the treatment of SUI, but further studies including long-term follow-up are mandatory to confirm these preliminary data.
Collapse
Affiliation(s)
- Muhammet F Kilinc
- Department of Urology, Ankara Training and Research Hospital, Medical Science University, Ankara, Turkey
| | - Yildiray Yildiz
- Department of Urology, Ankara Training and Research Hospital, Medical Science University, Ankara, Turkey
| | - Ahmet M Hascicek
- Department of Urology, Ankara Training and Research Hospital, Medical Science University, Ankara, Turkey
| | - Omer G Doluoglu
- Department of Urology, Ankara Training and Research Hospital, Medical Science University, Ankara, Turkey
| | - Eda Tokat
- Department of Urology, Ankara Training and Research Hospital, Medical Science University, Ankara, Turkey
| |
Collapse
|
3
|
Campos-Delgado M, Quetglas-Muñoz C, Barahona-Orpinell M, García-Tejedor A, Ponce-Sebastià J. Ambulatory MiniArc Precise Sling under Local Anesthesia for Stress Urinary Incontinence: Feasibility and Outcome. Gynecol Minim Invasive Ther 2019; 8:113-117. [PMID: 31544021 PMCID: PMC6743235 DOI: 10.4103/gmit.gmit_104_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 11/04/2022] Open
Abstract
Aims: The aim of the study is to assess the feasibility of ambulatory stress urinary incontinence (SUI) surgery using the MiniArc Precise single-incision urethral sling without increasing the number of complications. Settings and Design: This was a retrospective observational study of prospectively collected data carried out in a Tertiary Referral Hospital in Barcelona, Spain. Materials and Methods: Forty patients diagnosed with SUI or stress predominant mixed urinary incontinence (MUI) treated surgically between November 2011 and November 2013. The MiniArc Precise® sling was inserted under local anesthesia in the ambulatory setting. Statistical Analysis Used: Descriptive statistics included frequencies and percentages for categorical variables and mean and range for quantitative variables. The statistical package used was SPSS version 17.0. Results: Urodynamic studies showed SUI in 78% of cases and stress predominant MUI in 17%. Clinical findings included SUI in 56% of cases and MUI in 44%, with positive stress tests in all participants. The mean intraoperative pain (1–10 Visual Analog Scale) was 2. All patients were satisfied with the use of local anesthesia in the outpatient setting. Perioperative complications did not occur. One case of urinary retention and two cases of urinary tract infection (UTI) developed within this 1st month after operation and were successfully managed conservatively. Midterm complications included eight cases of UTI and four de novo urge incontinence. Conclusions: Placement of the MiniArc Precise sling under local anesthesia is a feasible and safe technique, which when carried out by an experienced surgeon allows to be done as an outpatient basis without increasing the rate of postprocedural complications.
Collapse
Affiliation(s)
- Miriam Campos-Delgado
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Cecilia Quetglas-Muñoz
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Marc Barahona-Orpinell
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Amparo García-Tejedor
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| | - Jordi Ponce-Sebastià
- Department of Gynecology, Bellvitge University Hospital, L'hospitalet De Llobregat, Barcelona, Spain
| |
Collapse
|
4
|
Golbasi C, Taner CE, Golbasi H. Long-term outcomes and quality of life effects of single incision mini sling procedure in stress urinary incontinence patients. Eur J Obstet Gynecol Reprod Biol 2019; 234:10-13. [PMID: 30634093 DOI: 10.1016/j.ejogrb.2018.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/21/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to evaluate the long-term outcomes and quality of life of patients who underwent single incision minisling (SIMS) procedure. STUDY DESIGN 62 patients who were diagnosed with stress urinary incontinence (SUI) and received treatment with SIMS procedure (Ophira, Promedon, Argentina) were included in the study. Mean age was 50.73 ± 9.28 years and mean follow-up duration after surgery was 30.68 ± 7.52 months. Preoperative urological and gynecological features of the patients were recorded. Gynecological examination, pelvic ultrasonography, stress test, Q-tip test, cystometry were performed and incontinence and quality of life questionnaires (ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI) were completed by all patients before and after the operation. RESULTS Stress urinary incontinence was observed in all patients during pre-op evaluations. 62 patients aged between 35-85 (mean age 50.73 ± 9.28) years were included and follow up duration ranged between 12-44 (average 30.68 ± 7.52) months. In regard to patient evaluations, 27 patients (43.5%) felt that the surgery was very effective, 25 (40.3%) felt surgery was effective and 10 (16.1%) did not report any difference after surgery. In the long-term postoperative follow up; 2 (3.2%) patients had dyspareunia and 7 (11.3%) patients had vaginal tape erosions which were diagnosed 2-40 months postoperatively. According to Q-tip test results, proximal urethral mobility was significantly decreased after surgery. All questionnaire scores were also significantly improved at post-operative evaluations. (P < 0.001) CONCLUSIONS: Our study confirmed that the Ophira mini sling technique provided high subjective cure rate and improved symptoms and quality of life in patients with SUI. These results suggest that the single incision mini sling procedure is an advisable alternative to other surgical procedures due to its low complication rates and ease of learning and applying the procedure. This procedure also demonstrated excellent tolerability, minimal pain, low morbidity and increased quality of life scores, in ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI.
Collapse
Affiliation(s)
- Ceren Golbasi
- Republic of Turkey, Ministry of Health University of Health Sciences Tepecik Education and Research Hospital, Turkey.
| | - Cuneyt Eftal Taner
- Republic of Turkey, Ministry of Health University of Health Sciences Tepecik Education and Research Hospital, Turkey
| | - Hakan Golbasi
- Republic of Turkey, Ministry of Health University of Health Sciences Tepecik Education and Research Hospital, Turkey
| |
Collapse
|
5
|
Nambiar A, Cody JD, Jeffery ST, Aluko P. Single-incision sling operations for urinary incontinence in women. Cochrane Database Syst Rev 2017; 7:CD008709. [PMID: 28746980 PMCID: PMC6483163 DOI: 10.1002/14651858.cd008709.pub3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urinary incontinence has been shown to affect up to 50% of women. Studies in the USA have shown that up to 80% of these women have an element of stress urinary incontinence. This imposes significant health and economic burden on society and the women affected. Colposuspension and now mid-urethral slings have been shown to be effective in treating patients with stress incontinence. However, associated adverse events include bladder and bowel injury, groin pain and haematoma formation. This has led to the development of third-generation single-incision slings, also referred to as mini-slings.It should be noted that TVT-Secur (Gynecare, Bridgewater, NJ, USA) is one type of single-incision sling; it has been withdrawn from the market because of poor results. However, it is one of the most widely studied single-incision slings and was used in several of the trials included in this review. Despite its withdrawal from clinical use, it was decided that data pertaining to this sling should be included in the first iteration of this review, so that level 1a data are available in the literature to confirm its lack of efficacy. OBJECTIVES To assess the effectiveness of mini-sling procedures in women with urodynamic clinical stress or mixed urinary incontinence in terms of improved continence status, quality of life or adverse events. SEARCH METHODS We searched: Cochrane Incontinence Specialised Register (includes: CENTRAL, MEDLINE, MEDLINE In-Process) (searched 6 February 2013); ClinicalTrials.gov, WHO ICTRP (searched 20 September 2012); reference lists. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with urodynamic stress incontinence, symptoms of stress incontinence or stress-predominant mixed urinary incontinence, in which at least one trial arm involves one of the new single-incision slings. The definition of a single-incision sling is "a sling that does not involve either a retropubic or transobturator passage of the tape or trocar and involves only a single vaginal incision (i.e. no exit wounds in the groin or lower abdomen)." DATA COLLECTION AND ANALYSIS Three review authors assessed the methodological quality of potentially eligible trials and independently extracted data from individual trials. MAIN RESULTS We identified 31 trials involving 3290 women. Some methodological flaws were observed in some trials; a summary of these is given in the 'Risk of bias in included studies' section.No studies compared single-incision slings versus no treatment, conservative treatment, colposuspension, laparoscopic procedures or traditional sub-urethral slings. No data on the comparison of single-incision slings versus retropubic mid-urethral slings (top-down approach) were available, but the review authors believe this did not affect the overall comparison versus retropubic mid-urethral slings.Types of single-incision slings included in this review: TVT-Secur (Gynecare); MiniArc (American Medical Systems, Minnetonka, USA); Ajust (CR Bard Inc., Covington, USA); Needleless (Mayumana Healthcare, Lisse, The Netherlands); Ophira (Promedon, Cordoba, Argentina); Tissue Fixation System (TFS PTY Ltd, Sydney, Australia) and CureMesh (DMed Co. Inc., Seoul, Korea).Women were more likely to remain incontinent after surgery with single-incision slings than with retropubic slings such as tension-free vaginal tape (TVTTM) (121/292, 41% vs 72/281, 26%; risk ratio (RR) 2.08, 95% confidence interval (CI) 1.04 to 4.14). Duration of the operation was slightly shorter for single-incision slings but with higher risk of de novo urgency (RR 2.39, 95% CI 1.25 to 4.56). Four of five studies in the comparison included TVT-Secur as the single-incision sling.Single-incision slings resulted in higher incontinence rates compared with inside-out transobturator slings (30% vs 11%; RR 2.55, 95% CI 1.93 to 3.36). The adverse event profile was significantly worse, specifically consisting of higher risks of vaginal mesh exposure (RR 3.75, 95% CI 1.42 to 9.86), bladder/urethral erosion (RR 17.79, 95% CI 1.06 to 298.88) and operative blood loss (mean difference 18.79, 95% CI 3.70 to 33.88). Postoperative pain was less common with single-incision slings (RR 0.29, 95% CI 0.20 to 0.43), and rates of long-term pain or discomfort were marginally lower, but the clinical significance of these differences is questionable. Most of these findings were derived from the trials involving TVT-Secur: Excluding the other trials showed that high risk of incontinence was principally associated with use of this device (RR 2.65, 95% CI 1.98 to 3.54). It has been withdrawn from clinical use.Evidence was insufficient to reveal a difference in incontinence rates with other single-incision slings compared with inside-out or outside-in transobturator slings. Duration of the operation was marginally shorter for single-incision slings compared with transobturator slings, but only by approximately two minutes and with significant heterogeneity in the comparison. Risks of postoperative and long-term groin/thigh pain were slightly lower with single-incision slings, but overall evidence was insufficient to suggest a significant difference in the adverse event profile for single-incision slings compared with transobturator slings. Evidence was also insufficient to permit a meaningful sensitivity analysis of the other single-incision slings compared with transobturator slings, as all confidence intervals were wide. The only significant differences were observed in rates of postoperative and long-term pain, and in duration of the operation, which marginally favoured single-incision slings.Overall results show that TVT-Secur is considerably inferior to retropubic and inside-out transobturator slings, but additional evidence is required to allow any reasonable comparison of other single-incision slings versus transobturator slings.When one single-incision sling was compared with another, evidence was insufficient to suggest a significant difference between any of the slings in any of the comparisons made. AUTHORS' CONCLUSIONS TVT-Secur is inferior to standard mid-urethral slings for the treatment of women with stress incontinence and has already been withdrawn from clinical use. Not enough evidence has been found on other single-incision slings compared with retropubic or transobturator slings to allow reliable comparisons. A brief economic commentary (BEC) identified two studies which reported no difference in clinical outcomes between single-incision slings and transobturator mid-urethral slings, but single-incision slings may be more cost-effective than transobturator mid-urethral slings based on one-year follow-up. Additional adequately powered and high-quality trials with longer-term follow-up are required. Trials should clearly describe the fixation mechanism of these single-incisions slings: It is apparent that, although clubbed together as a single group, a significant difference in fixation mechanisms may influence outcomes.
Collapse
Affiliation(s)
- Arjun Nambiar
- Health Education North East/Freeman HospitalDepartment of UrologyFreeman RoadHigh HeatonNewcastle‐upon‐TyneTyne and WearUKNE7 7DN
| | - June D Cody
- Newcastle Universityc/o Cochrane Incontinence GroupInstitute of Health & SocietyBaddiley‐Clarke Building, Richardson RoadNewcastle upon TyneTyne and WearUKNE2 4AX
| | - Stephen T Jeffery
- Groote Schuur Hospital and University of Cape TownObstetrics and GynaecologyAnzio RoadObservatoryCape TownWestern CapeSouth Africa8001
| | - Patricia Aluko
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle Upon TyneUKNE2 4AX
| | | |
Collapse
|
6
|
To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women. Med J Armed Forces India 2017; 73:36-41. [PMID: 28123243 DOI: 10.1016/j.mjafi.2016.07.010] [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: 01/05/2016] [Accepted: 07/20/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women. METHODS 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year. RESULTS The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% (n = 1), urethral injury in 5% (n = 1) and urethral tape exposure in 10% (n = 2), at 3 months requiring tape sectioning. CONCLUSIONS These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.
Collapse
|
7
|
Tieu AL, Hegde A, Castillo PA, Davila GW, Aguilar VC. Transobturator versus single incision slings: 1-year results of a randomized controlled trial. Int Urogynecol J 2016; 28:461-467. [DOI: 10.1007/s00192-016-3128-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/18/2016] [Indexed: 10/20/2022]
|
8
|
Tension-releasing suture appendage on single-incision sling device: A novel approach to postoperative voiding dysfunctions. Taiwan J Obstet Gynecol 2016; 55:519-24. [DOI: 10.1016/j.tjog.2015.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/21/2022] Open
|
9
|
Gambini-Ricapa J, García-Oms J, Barea M, Estrada A, Iturri A, Gambini-Buchon J, Gilabert-Estelles J. Endopelvic free anchor minisling technique for stress urinary incontinence treatment: 10 years of experience. Int Urogynecol J 2016; 27:1265-72. [PMID: 26864665 DOI: 10.1007/s00192-016-2958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present our 10-year experience in treating stress urinary incontinence (SUI) using a new minisling technique based on a tension-free vaginal tape band designed by our group. The major advantage of this tape is the use of minibelt polypropylene inserted through a single retropubic incision without the use of needles-the Endopelvic Free Anchor (EFA)-based on its location at the midurethra with a U shape. For insertion, each branch is placed using a simple Pean clamp from the vagina with perforation of the endopelvic fascia to achieve a retropubic insertion. METHODS From May 2001 to May 2011, we surgically treated 166 women with primary first- or second-degree SUI due to urethral hypermobility without genital prolapse. All were evaluated according to our study protocol, which included clinical and urodynamic evaluation before and 12 months after surgery. RESULTS With a median follow-up of 5 (1-11) years, 152 patients (91.6 %) were fully cured both from urodynamic and subjective points of view. Six patients (3.6 %) had significant improvement, and eight (4.8 %) were identified as technique failure. Complications included one bladder perforation (0.6 %), two cases of postoperative urinary retention (1.24 %), two of retropubic hematoma (1.24 %), and one of de novo urgency (0.6 %). No reinterventions were necessary, and there were no major bleeding complications, no chronic pain or de novo dyspareunia, and no voiding difficulty. CONCLUSIONS EFA is a viable, safe, and effective technique for treating UI due to urethral hypermobility.
Collapse
Affiliation(s)
- Juan Gambini-Ricapa
- Unidad de Endoscopia y Oncología Ginecológica, Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Javier García-Oms
- Unidad de Endoscopia y Oncología Ginecológica, Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Miguel Barea
- Unidad de Endoscopia y Oncología Ginecológica, Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Angeles Estrada
- Unidad de Endoscopia y Oncología Ginecológica, Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Alejandra Iturri
- Unidad de Endoscopia y Oncología Ginecológica, Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Juan Gambini-Buchon
- Departamento de Fisiología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Juan Gilabert-Estelles
- Unidad de Endoscopia y Oncología Ginecológica, Hospital General Universitario de Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain.
- Departamento de Pediatria, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
| |
Collapse
|
10
|
Sharifiaghdas F, Nasiri M, Mirzaei M, Narouie B. Mini Sling (Ophira) versus Pubovaginal Sling for Treatment of Stress Urinary Incontinence: A Medium-term Follow-up. Prague Med Rep 2015; 116:210-8. [PMID: 26445392 DOI: 10.14712/23362936.2015.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To compare two different procedures, mid-urethral mini sling (Ophira) and autologous rectus fascia sling, according to their medium-term subjective and objective outcome and satisfaction rates in the treatment of stress urinary incontinence in women. One hundred women with the main complaint of stress urinary incontinence were randomized to be treated with either mini sling (Ophira) or autologous rectus facia pubovaginal sling. Preoperative evaluation consisted of: physical examination, blood biochemistry urine analysis and culture, urinary tract ultrasound scan, conventional multi-channel urodynamic study, cystourethroscopy, cough induced stress test and Incontinence Impact Questionnaire (IIQ). The patients were objectively and subjectively re-evaluated at 1, 3, 6 and 12 postoperative months and the last visit and the collected data of more than one year follow-up were compared with preoperative assessments. Seventy two out of one hundred patients were followed for a mean time of 13.8±4.4 months (12-20 months range). Objective cure rate, according to cough-induced stress test was recorded in 88.6% and 89.2% of the mini sling (Ophira) and the rectus facia sling group respectively (P=1.0). Postoperative mean IIQ score decreased to 42.7±11.4 and 50.2±11.1 in the mini sling (Ophira) group versus rectus facia pubovaginal sling (P=0.007). Twenty eight (80%) and 23 (67%) patients in the mini sling (Ophira) and rectus facia pubovaginal sling were satisfied with the operation (P=0.23). There is no significant difference between the mini sling (Ophira) and autologous rectus fascia sling procedure in the treatment of stress urinary incontinence at medium-term follow-up.
Collapse
Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoodreza Nasiri
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Mirzaei
- Department of Urology, Kerman University of Medical Sciences, Kerman, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran. .,Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
11
|
Lo TS, Tan YL, Wu PY, Cortes EFM, Pue LB, Al-Kharabsheh A. Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). Eur J Obstet Gynecol Reprod Biol 2014; 182:91-7. [PMID: 25265496 DOI: 10.1016/j.ejogrb.2014.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI). STUDY DESIGN This was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2 g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking. RESULTS Postoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05). CONCLUSIONS In conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Yiap Loong Tan
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Sarawak General Hospital & Kuching Specialist Hospital (KPJ), Kuching, Sarawak, Malaysia
| | - Pei-Ying Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Eileen Feliz M Cortes
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines
| | - Leng Boi Pue
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Hospital Serdang, Kajang, Selangor, Malaysia
| | - Ahlam Al-Kharabsheh
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, King Abdullah University Hospital/University of Science & Technology, Irbid, Jordan
| |
Collapse
|
12
|
Taner CE, Okay G, Göklü Y, Başoğul Ö, Başoğul N. Perioperative and postoperative complications after Ophira mini sling operations. Arch Gynecol Obstet 2014; 291:341-6. [PMID: 25138122 DOI: 10.1007/s00404-014-3402-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Cüneyt Eftal Taner
- Ministry of Health Tepecik Education and Research Hospital, Izmir, Turkey
| | | | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND Urinary incontinence has been shown to affect up to 50% of women. Studies in the United States have shown that up to 80% of these women have an element of stress urinary incontinence. Colposuspension and now mid-urethral slings have been shown to be effective in treating patients with stress incontinence. However, associated adverse events include bladder and bowel injury, groin pain and haematoma formation. This has led to the development of third-generation single-incision slings, also referred to as mini-slings.It should be noted that TVT-Secur (Gynecare, Bridgewater, NJ, USA) is one type of single-incision sling; it has been withdrawn from the market because of poor results. However, it is one of the most widely studied single-incision slings and was used in several of the trials included in this review. Despite its withdrawal from clinical use, it was decided that data pertaining to this sling should be included in the first iteration of this review, so that level 1a data are available in the literature to confirm its lack of efficacy. OBJECTIVES To assess the effectiveness of mini-sling procedures in women with urodynamic clinical stress or mixed urinary incontinence in terms of improved continence status, quality of life or adverse events. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process; we handsearched journals and conference proceedings (searched 6 February 2013) and searched ClinicalTrials.gov (searched 20 September 2012), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 20 September 2012) and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with urodynamic stress incontinence, symptoms of stress incontinence or stress-predominant mixed urinary incontinence, in which at least one trial arm involves one of the new single-incision slings. The definition of a single-incision sling is "a sling that does not involve either a retropubic or transobturator passage of the tape or trocar and involves only a single vaginal incision (i.e. no exit wounds in the groin or lower abdomen)." DATA COLLECTION AND ANALYSIS Three review authors assessed the methodological quality of potentially eligible trials and independently extracted data from the individual trials. MAIN RESULTS We identified 31 trials involving 3290 women. Some methodological flaws were observed in some trials; a summary of these is given in the 'Risk of bias in included studies' section.No studies compared single-incision slings versus no treatment, conservative treatment, colposuspension, laparoscopic procedures or traditional sub-urethral slings. Also no data on the comparison of single-incision slings versus retropubic mid-urethral slings (top-down approach) were available, but the review authors believe this did not affect the overall comparison versus retropubic mid-urethral slings.The types of single-incision slings included in this review were TVT-Secur (Gynecare), MiniArc (American Medical Systems, Minnetonka, MN, USA), Ajust (C.R. Bard, Inc.,Covington, GA, USA), Needleless (Mayumana Healthcare, Lisse, The Netherlands), Ophira (Promedon, Cordoba, Argentina), Tissue Fixation System (TFS PTY Ltd, Sydney, Australia) and CureMesh (D.Med. Co., Inc., Seoul, Korea).Women were more likely to remain incontinent after surgery with single-incision slings than with retropubic slings such as tension-free vaginal tape (TVT(TM)) (121/292, 41% vs 72/281, 26%; risk ratio (RR) 2.08, 95% confidence interval (CI) 1.04 to 4.14). Duration of the operation was slightly shorter for single-incision slings but with higher risk of de novo urgency (RR 2.39, 95% CI 1.25 to 4.56). Four of five studies in the comparison included TVT-Secur as the single-incision sling.Single-incision slings resulted in higher incontinence rates compared with inside-out transobturator slings (30% vs 11%; RR 2.55, 95% CI 1.93 to 3.36). The adverse event profile was significantly worse, specifically consisting of higher risks of vaginal mesh exposure (RR 3.75, 95% CI 1.42 to 9.86), bladder/urethral erosion (RR 17.79, 95% CI 1.06 to 298.88) and operative blood loss (mean difference 18.79, 95% CI 3.70 to 33.88). Postoperative pain was less common with single-incision slings (RR 0.29, 95% CI 0.20 to 0.43), and rates of long-term pain or discomfort were marginally lower, but the clinical significance of these differences is questionable. Most of these findings were derived from the trials involving TVT-Secur: Excluding the other trials showed that high risk of incontinence was principally associated with use of this device (RR 2.65, 95% CI 1.98 to 3.54). It has been withdrawn from clinical use.Evidence was insufficient to reveal a difference in incontinence rates with other single-incision slings compared with inside-out or outside-in transobturator slings. Duration of the operation was marginally shorter for single-incision slings compared with transobturator slings, but only by approximately two minutes and with significant heterogeneity in the comparison. Risks of postoperative and long-term groin/thigh pain were slightly lower with single-incision slings, but overall evidence was insufficient to suggest a significant difference in the adverse event profile for single-incision slings compared with transobturator slings. Evidence was also insufficient to permit a meaningful sensitivity analysis of the other single-incision slings compared with transobturator slings, as all confidence intervals were wide. The only significant differences were observed in rates of postoperative and long-term pain, and in duration of the operation, which marginally favoured single-incision slings.Overall results show that TVT-Secur is considerably inferior to retropubic and inside-out transobturator slings, but additional evidence is required to allow any reasonable comparison of other single-incision slings versus transobturator slings.When one single-incision sling was compared with another, evidence was insufficient to suggest a significant difference between any of the slings in any of the comparisons made. AUTHORS' CONCLUSIONS TVT-Secur is inferior to standard mid-urethral slings for the treatment of women with stress incontinence and has already been withdrawn from clinical use. Not enough evidence has been found on other single-incision slings compared with retropubic or transobturator slings to allow reliable comparisons. Additional adequately powered and high-quality trials with longer-term follow-up are required. Trials should clearly describe the fixation mechanism of these single-incisions slings: It is apparent that, although clubbed together as a single group, a significant difference in fixation mechanisms may influence outcomes.
Collapse
Affiliation(s)
- Arjun Nambiar
- Department of Urology, Ward H, Morriston Hospital, Swansea, UK, SA6 6NL
| | | | | |
Collapse
|
14
|
Dias J, Xambre L, Costa L, Costa P, Ferraz L. Short-term outcomes of Altis single-incision sling procedure for stress urinary incontinence: a prospective single-center study. Int Urogynecol J 2014; 25:1089-95. [PMID: 24599178 DOI: 10.1007/s00192-014-2355-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/07/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Data on Altis® (Coloplast), a new adjustable single-incision sling (SIS) procedure for the treatment of female stress urinary incontinence (SUI), are scarce. Our aim was to evaluate the efficacy and complication rates of this procedure. METHODS In this prospective observational study, a total of 52 women with SUI were implanted with an Altis sling in an ambulatory setting. Before and after intervention (3, 6, and 12 months), women completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). In addition, patients underwent a cough stress test at each evaluation and a post-voiding residual urine volume estimation at 3 months. The main outcomes measured were subjective cure (ICIQ-SF = 0), subjective improvement (ICIQ-SF >0 and < preoperative ICIQ-SF), and objective cure (negative cough stress test and no pad usage) rates. De novo overactive bladder (OAB) symptoms, changes in voiding habits and adverse events were also analyzed. RESULTS The subjective cure rate at 12 months was 84.0%, with an additional improvement rate of 8.0%. The objective cure rate was 90.2%. Later postoperative complications included 1 case of vaginal extrusion (requiring surgical removal of the eroded mesh segment), 3 cases of vaginal exposure of the adjustment thread (managed conservatively), de novo urgency in 3 patients, and mild dyspareunia in 2 patients. CONCLUSIONS The Altis sling is a safe and effective SIS procedure for the treatment of SUI with a short-term follow-up.
Collapse
Affiliation(s)
- Jorge Dias
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal,
| | | | | | | | | |
Collapse
|
15
|
MARTAN A, KRHUT J, MAŠATA J, ŠVABÍK K, HALAŠKA M, HORČIČKA L, ZACHOVAL R. Prospective Randomized Study of MiniArc and Ajust Single Incision Sling Procedures. Low Urin Tract Symptoms 2013; 6:172-4. [DOI: 10.1111/luts.12041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/28/2013] [Accepted: 09/11/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Alois MARTAN
- Department of Obstetrics and Gynecology; Charles University and General Faculty Hospital in Prague; Prague Czech Republic
| | - Jan KRHUT
- Department of Urology; Ostrava University; Ostrava Czech Republic
| | - Jaromír MAŠATA
- Department of Obstetrics and Gynecology; Charles University and General Faculty Hospital in Prague; Prague Czech Republic
| | - Kamil ŠVABÍK
- Department of Obstetrics and Gynecology; Charles University and General Faculty Hospital in Prague; Prague Czech Republic
| | - Michael HALAŠKA
- Department of Obstetrics and Gynecology; Charles University and Faculty Hospital, Bulovka; Prague Czech Republic
| | - Lukáš HORČIČKA
- GONA - Outpatient Clinic of Obstetrics and Gynecology; Prague Czech Republic
| | - Roman ZACHOVAL
- Department of Urology; Thomayer Hospital; Prague Czech Republic
- Department of Urology; 1st Faculty of Medicine, Charles University and General Faculty Hospital; Prague Czech Republic
| |
Collapse
|
16
|
Lizée D, Cornu JN, Peyrat L, Ciofu C, Beley S, Haab F. Mini-bandelettes pour le traitement de l’incontinence urinaire d’effort féminine : revue de la littérature. Prog Urol 2013; 23:917-25. [DOI: 10.1016/j.purol.2013.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 01/01/2023]
|
17
|
Castellier C, Doucède G, Debodinance P. [Place of the mini-sling in the treatment of female stress urinary incontinence]. ACTA ACUST UNITED AC 2013; 42:639-46. [PMID: 23973118 DOI: 10.1016/j.jgyn.2013.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Evaluate the place of sub-urethral mini-slings in the treatment of female stress urinary incontinence. MATERIAL AND METHODS Review of the literature on 43 publications (comparative and prospective studies) more than 6443 patients who underwent for the treatment of urinary incontinence, a mini-strip type TVT®, TVT-S®, MiniArc®, Ajust®, Needleless®, Solyx®, or Ophira® in comparison to the conventional urethral sling. The comparison used objective (cough stress test and pad weight test) and subjective criteria (quality of life questionnaire). The papers have also studied the complication associated with these new techniques. RESULTS The overall effectiveness of this surgery varied between 40 to 84% for TVT-S®, 69 to 92% for MiniArc®, 80 to 91% for Ajust®, 87% for Needleless®, 95% for Solyx® and 85% for Ophira®. The efficacy on incontinence was higher with the TVT® TVT-S® and the MiniArc® (P=0.01 to 0.05). TVT-O® efficacy was higher than TVT-S® (P<0.01 and P=0.02). Conventional slings seems to be more efficient than TVT-S® and MiniArc® mini-slings. Ajust® mini-sling seems to be as efficient as MiniArc® and TVT-S® mini-sling and TVT-O®. It showed a decrease in the intensity of postoperative pain (P<0.001), faster return to normal activities (P=0.025) and use of a common local anesthetic to the adjustable mini-sling. CONCLUSION It seems that the adjustable mini-sling is currently the best compromise in terms of effectiveness and complications if the choice had to be among the mini-sling in the treatment of stress urinary incontinence.
Collapse
Affiliation(s)
- C Castellier
- Département de gynécologie-obstétrique, centre hospitalier Dunkerque, GCS Flandre-Maritime, avenue de la Polyclinique, 59760 Grande-Synthe, France
| | | | | |
Collapse
|
18
|
Ahn KH, Alvarez J, Dwyer PL. Recent Developments in the Surgical Management of Urinary Stress Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0046-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
19
|
Basu M, Duckett J. Three-year results from a randomised trial of a retropubic mid-urethral sling versus the Miniarc single incision sling for stress urinary incontinence. Int Urogynecol J 2013; 24:2059-64. [PMID: 23712578 DOI: 10.1007/s00192-013-2125-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/28/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There are limited long-term efficacy data on single-incision slings. The primary aim of this study was to evaluate the success rate of a single-incision sling versus a retropubic mid-urethral sling for cure of SUI at 3 years' follow-up, in order to assess whether there is a deterioration in efficacy over time. The secondary aims were to assess re-operation rates for each procedure and to evaluate any differences in disease-specific quality of life. METHODS This study was a 3-year questionnaire-based follow-up of a randomised controlled trial of the Miniarc single-incision sling versus the Advantage retropubic mid-urethral sling. Patients were considered failures if they documented stress incontinence on the symptom domain of the King's Health questionnaire (KHQ) or had undergone repeat surgery for stress incontinence. RESULTS Follow-up was available from 35 out of 38 women in the single-incision sling group (92.1 %) and from 26 out of 33 in the retropubic mid-urethral sling group (79.0 %). The overall 3-year failure rate was 20 out of 38 (52.6 %) in the single-incision sling group and 3 out of 33 (9.0 %) in the retropubic mid-urethral sling group (odds ratio 10.0, 95 % confidence interval 2.6-38.4). In the single-incision sling group, the failure rate increased from 40.5 % at 6 months to 52.6 % at 3 years with corresponding figures of 3 to 9 % in the retropubic mid-urethral sling group. CONCLUSIONS In this study, there was a significantly higher 3-year failure rate for the single-incision sling versus the retropubic mid-urethral sling. Both procedures had reduced efficacy over time.
Collapse
Affiliation(s)
- Maya Basu
- Department of Urogynaecology and Pelvic Reconstructive Surgery, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK,
| | | |
Collapse
|
20
|
Cox A, Herschorn S, Lee L. Surgical management of female SUI: is there a gold standard? Nat Rev Urol 2013; 10:78-89. [PMID: 23318365 DOI: 10.1038/nrurol.2012.243] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Many surgical options exist for women with stress urinary incontinence (SUI). The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings--inserted via a retropubic or transobturator approach--have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications. Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery. Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. Based on the literature a new gold standard first-line surgical treatment for women with SUI is the synthetic midurethral sling inserted through a retropubic or transobturator approach [corrected].
Collapse
Affiliation(s)
- Ashley Cox
- Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Room MG 408, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | | | | |
Collapse
|
21
|
A comparative study of a single-incision sling and a transobturator sling: clinical efficacy and urodynamic changes. Int Urogynecol J 2012; 24:823-9. [PMID: 23052630 DOI: 10.1007/s00192-012-1942-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In this retrospective study, a comparison is made of the clinical efficacy of two stress urinary incontinence treatment apparatuses, a single-incision sling and a transobturator sling. METHODS Eighty-five (single-incision n=43, transobturator n=42) consecutive patients were included in this study. Clinical outcomes were assessed by the cough stress test (CST), the pad test, the Impact Questionnaire-Short Form (IIQ-7), the Urogenital Distress Inventory six-item questionnaire (UDI-6), the Sexual Questionnaire-SF (PIS-Q), the pain score, and the postoperative changes in urodynamic parameters. A comparison of the 1-year follow-up data is presented. RESULTS Three months post-surgery, 81.8% of the single-incision sling group and 74.4% of the transobturator sling group had a negative cough test and a dry pad test. One year after surgery, significantly decreasing UDI-6, IIQ-7, and increasing PIS-Q scores were observed in both groups, while the complication rates remained similar. Postoperatively, the single-incision sling group seems to show a greater improvement in UDI-6 score, require less operation time, and experience less blood loss, less postoperative pain, and a smaller decrease in maximal urethral closure pressure (MUCP). CONCLUSIONS These results suggest that the single-incision sling and the transobturator sling are equally as effective and safe for the treatment of stress incontinence, as evaluated during the 1-year follow-up. The insertion of a single-incision sling seems to be less painful than that of a conventional sling. One year after surgery, the MUCP and mean flow rate of the transobturator sling group had significantly decreased compared with that of the single-incision sling group.
Collapse
|
22
|
Tommaselli GA, Di Carlo C, Formisano C, Fabozzi A, Nappi C. TVT-Secur for the treatment of female stress urinary incontinence: a 24-month follow-up retrospective study. Arch Gynecol Obstet 2012; 286:415-21. [PMID: 22487886 DOI: 10.1007/s00404-012-2322-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/27/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the mid-term efficacy and safety of the TVT-Secur device in the treatment of stress urinary incontinence. STUDY DESIGN Retrospective study evaluating 68 women affected by stress urinary incontinence treated with TVT-Secur procedure with hammock approach who attended the 24-month follow-up visit. Stress test, urodynamics, patient functional and quality of life questionnaires, visual analog scale pain score, and post-operative complications were evaluated. Data distribution was evaluated using the Shapiro-Wilk's test. Data were analyzed by the Student's t test for parametric variables, the Wilcoxon test for non-parametric variables, and the Chi-squared test for categorized variables. RESULTS Objective cure rate 24 months after surgery was 80.8 %. Incontinence-quality of life and patient global impression of severity scores showed significant improvement. The only intra-operative complications were a vaginal wall tear and a case of severe bleeding, while post-operative complications were de novo urgency in five cases (7.3 %), one acute urinary retention (1.4 %), and one tape exposure (1.4 %). The study is limited by the retrospective design and the heterogeneity of patients. CONCLUSIONS TVT-Secur seems to be an effective and safe procedure for stress urinary incontinence.
Collapse
Affiliation(s)
- Giovanni A Tommaselli
- Department of Obstetrics and Gynecology, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy.
| | | | | | | | | |
Collapse
|
23
|
The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up. Int Urogynecol J 2011; 23:589-95. [PMID: 22109702 PMCID: PMC3332378 DOI: 10.1007/s00192-011-1605-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 10/28/2011] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence. Methods Seventy-seven patients, operated on from March 2008 to November 2009, were evaluated in this study. One-year post-operative data are presented. All patients suffered from predominant stress urinary incontinence. After 1 year, response was 74%. Evaluation was performed using a questionnaire consisting of the EuroQol-5 Dimensions, the Patient Global Impression of Improvement, the Incontinence Impact Questionnaire, the Urinary Distress Inventory, the Prolapse/Urinary Incontinence Sexual Questionnaire, short form, and the Defecation Distress Inventory. Results One year after surgery, 68% of the patients stated an improvement in their incontinence status, while only 44% stated to be completely dry. Conclusion The 1-year follow-up suggests that the MiniArc is less effective in the treatment of stress urinary incontinence than the TVT.
Collapse
|
24
|
Brito LMO, Sousa ADPS, Figueiredo Neto JAD, Duarte TB, Pinheiro GDL, Chein MBDC. Comparison of the outcomes of the sling technique using a commercial and hand-made polypropylene sling. Int Braz J Urol 2011; 37:519-27. [DOI: 10.1590/s1677-55382011000400012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2010] [Indexed: 11/22/2022] Open
|
25
|
Rehder P, Glodny B, Pichler R, Mitterberger MJ. Massive retropubic hematoma after minimal invasive mid-urethral sling procedure in a patient with a corona mortis. Indian J Urol 2011; 26:577-9. [PMID: 21369394 PMCID: PMC3034070 DOI: 10.4103/0970-1591.74467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
New and minimal invasive single incision mid-urethral sling procedures are available for treating female stress urinary incontinence. We present a case of a massive retropubic hematoma in a patient with a “corona mortis” artery following a minimal invasive sling procedure. The patient was managed conservatively. The hematoma resolved and the patient remained continent after surgery. Nature and symptoms of sling-related complications should prompt the diagnosis and appropriate postoperative management. One should always be conscious of possible vascular anomalies that might lead to unexpected complications.
Collapse
Affiliation(s)
- Peter Rehder
- Medical University Innsbruck, Department of Urology, Innsbruck, Austria
| | | | | | | |
Collapse
|
26
|
Oliveira R, Botelho F, Silva P, Resende A, Silva C, Dinis P, Cruz F. Single-incision sling system as primary treatment of female stress urinary incontinence: prospective 12 months data from a single institution. BJU Int 2011; 108:1616-21. [PMID: 21457429 DOI: 10.1111/j.1464-410x.2011.10158.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the success and complication rates for Mini-Arc(TM) single incision sling in the treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS A total of 119 female patients with pure SUI were enrolled in a prospective study. From these, 105 were available with a minimum follow-up of 6 months and a mean follow-up of 12 months. Success, as determined by patient- reported outcomes, and complication rates, as well as impact of learning curve, body mass index (BMI), intrinsic sphincter deficiency (ISD), incontinence severity and age were investigated. RESULTS Cure rate was 80% and improvement rate was 11%. Pain intensity was minimal on a visual analogue scale and transient urinary retention occurred in three patients, one requiring sling section. De novo urgency was reported by 6% of women. Severe incontinence was less likely to be cured: 70% if >5 pads per day (ppd); 94% if <2 ppd; 94% if 2-4 ppd, P < 0.05). There was no difference in success rates between the first 50 and the last 50 patients. BMI, ISD and age also did not influence success rate. CONCLUSION Mini-Arc™ attained high success rates at 1 year follow-up. The procedure was easy to learn and was associated with very low and mild morbidity. Severe incontinence was identified as a risk factor for failure.
Collapse
Affiliation(s)
- Rui Oliveira
- Hospital de São João, Serviço de Urologia, Porto, Portugal
| | | | | | | | | | | | | |
Collapse
|
27
|
Fong EDM, Nitti VW. Review article: Mid-urethral synthetic slings for female stress urinary incontinence. BJU Int 2010; 106:596-608. [PMID: 21050350 DOI: 10.1111/j.1464-410x.2010.09544.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
• Mid-urethral synthetic slings (MUSS) have grown in acceptance and popularity to gain a foremost position in stress urinary incontinence (SUI) surgery. • There are numerous studies that provide a large amount of Level 1 and 2 evidence that support the concept of a sling placed at the level of the mid-urethra. • Long-term follow-up has been published for the original tension-free vaginal tape (TVT) procedure with the most recent publication providing Level 2 evidence with mean follow-up of 11.5 years of 69/91 (77%) of patients from the original series. There was objective cure was in 90% of women and 77% considered themselves subjectively cured, based on the Patient Global Impression of Improvement. • Level 1 evidence with long-term follow-up has been provided comparing colposuspension to TVT at 2 and 5 years. At 5 years for the primary efficacy variable of a negative 1 h stress pad test, there was no difference in success (81% vs 90%). • Two recent meta-analyses provide Level 1 evidence comparing outcomes for retropubic vs transobturator MUSS. One included 18 studies, randomized and cohort: cohort studies had a 12.3% failure rate for transobturator and 13.7% failure for the retropubic approach, randomized studies showed 5.7% failure in the transobturator vs 7.8% in the retropubic group. The other meta-analysis included 11 studies published 2008-2009, which found that the short-term cure rate was borderline inferior for the transobturator tape group (odds ratio 0.62; 95% confidence interval 0.37-1.00), nearly reaching statistical significance (P= 0.05). • This review details further comparator evidence and evidence for use in specific patient groups (elderly, obese, intrinsic sphincter deficiency, mixed UI).
Collapse
Affiliation(s)
- Eva D M Fong
- Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
| | | |
Collapse
|
28
|
Álvarez-Bandrés S, Hualde-Alfaro A, Jiménez-Calvo J, Cebrián-Lostal J, Jiménez-Parra J, García-García D, Montesino-Semper M. Complicaciones de la cirugía de incontinencia urinaria femenina con minicintas. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Deole N, Kaufmann A, Arunkalaivanan A. Evaluation of safety and efficacy of single-incision mid-urethral short tape procedure (MiniArc™ tape) for stress urinary incontinence under local anaesthesia. Int Urogynecol J 2010; 22:335-9. [PMID: 20938645 DOI: 10.1007/s00192-010-1284-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 09/19/2010] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess complications and short-term results (3 months and 1 year) from a single-incision mid-urethral tape for stress urinary incontinence. METHODS Seventy-four women underwent single-incision mid-urethral tape under local anaesthesia, 59 of whom completed a 1-year follow-up. Thirty-seven (50%) suffered urodynamic stress urinary incontinence. The International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF) was completed in the context of the case history pre-operatively and post-operatively. The duration of follow-up ranged from 91 to 466 days. RESULTS The use of MiniArc™ tape in our study resulted in the objective cure rate (negative cough stress test) of 74% and 66% at 3 months and 1 year, respectively. Scores with ICIQ-SF questionnaire improved significantly at 3 months and 1 year (p < 0.0001). No major intra-operative complication was reported in our study. CONCLUSIONS Despite the advantage of being done under local anaesthetic, the overall cure rate is 66% at 1 year.
Collapse
Affiliation(s)
- Nishigandh Deole
- Department of Gynecology, City Hospital, Dudley Road, Birmingham B18 7QH, UK
| | | | | |
Collapse
|
30
|
[Sub-urethral sling in the treatment of female urinary incontinence: which? how?]. ACTA ACUST UNITED AC 2010; 38:607-19. [PMID: 20880735 DOI: 10.1016/j.gyobfe.2010.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 05/03/2010] [Indexed: 11/23/2022]
Abstract
Review of the literature that formed the basis for drafting the guideline on the sub-uretral sling in the first-line surgical treatment of female stress urinary incontinence. Medline database query since the introduction of TVT on the questions of various chapters and sub-chapters of the present article. The use of tapes made of polypropylene monofilament exclusively, knitted, is recommended to the exclusion of any other material. Regarding the choice of procedure, the objective cure rate of transobturator and retro-pubic routes cannot be evaluated clearly because of vague evaluation criteria from one study to another. Without adequate clinical trials proving their efficacy and safety, the mini-bands can so far be recommended to treat female stress urinary incontinence. Moderate overweight does not affect the results of laying tape. In patients with severe obesity, surgery to correct obesity is even better than surgery for incontinence. Age is not a contra-indication. If the patient is young and nulliparous, it is reasonable to advise her to postpone surgery after her last pregnancy. In case of multiparous patient, the risk of vaginal delivery does not seem sufficient to suggest a cesarean section. To conclude, sub-urethral slings are the first-line surgical treatment of female stress urinary incontinence.
Collapse
|
31
|
Jeffery ST, De Jong P, Abdool Z, Van Wijk F, Lucente V, Murphy M. Single-incision sling operations for urinary incontinence in women. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
32
|
Hoda MR, Wagner S, Greco F, Heynemann H, Fornara P. Pelvic Organ Prolapse Management in Female Kidney Transplant Recipients. J Urol 2010; 184:1064-8. [DOI: 10.1016/j.juro.2010.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Indexed: 10/19/2022]
Affiliation(s)
- M. Raschid Hoda
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Halle/Wittenberg, Halle (Saale), Germany
| | - Sigrid Wagner
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Halle/Wittenberg, Halle (Saale), Germany
| | - Francesco Greco
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Halle/Wittenberg, Halle (Saale), Germany
| | - Hans Heynemann
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Halle/Wittenberg, Halle (Saale), Germany
| | - Paolo Fornara
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Halle/Wittenberg, Halle (Saale), Germany
| |
Collapse
|
33
|
Kennelly MJ, Moore R, Nguyen JN, Lukban JC, Siegel S. Prospective evaluation of a single incision sling for stress urinary incontinence. J Urol 2010; 184:604-9. [PMID: 20639024 DOI: 10.1016/j.juro.2010.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Indexed: 12/18/2022]
Abstract
PURPOSE We report 12-month outcomes of the MiniArc single incision sling for stress urinary incontinence in women. MATERIALS AND METHODS We performed a multicenter, prospective, single arm institutional review board/ethics committee approved study evaluating the effectiveness of the MiniArc sling after implantation via qualitative (Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form) and quantitative (1-hour pad weight test and cough stress test) measurements. Secondary outcome measures included procedural variables (procedure time and estimated blood loss), length of stay, perioperative complications, Wong-Baker Faces Pain Scale and adverse events. RESULTS A total of 188 women with a mean age of 51.1 +/- 10.6 years (median 50.4, range 25.9 to 79.6) were enrolled in the study. At 1 year 157 patients were available for analysis. Mean procedure time, estimated blood loss and length of hospital stay were 11.0 +/- 6.7 minutes (median 10, range 2 to 55), 41.7 +/- 47.0 ml (median 25, range 0 to 250) and 9.5 +/- 14.1 hours (median 3.2, range 0.5 to 77.2), respectively. At discharge from hospital the mean Wong-Baker pain score was 1.3 +/- 2.0 (range 0.0 to 10.0). Of the patients 90.6% had a negative cough stress test and 84.5% had a 1-hour pad weight test less than 1 gm at 12 months. Median Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form scores showed a statistically significant decrease (p <0.001). Adverse events included urinary tract infection (4.3%), constipation (3.7%), temporary urinary retention (3.2%), dyspareunia (2.1%) and vaginal extrusion (1.6%). CONCLUSIONS The MiniArc single incision sling is a safe and effective first line surgical procedure for the treatment of female stress urinary incontinence. It demonstrated excellent patient tolerability with minimal pain, early return to normal activity and low morbidity. In addition to sustained efficacy outcomes at 12 months patients treated with the MiniArc experienced a significant improvement in quality of life.
Collapse
|
34
|
Lee KS, Lee YS, Seo JT, Na YG, Choo MS, Kim JC, Seo JH, Yoon JM, Lee JG, Kim DY, Yoo ES, Min KS, Hong JY, Lee JZ. A Prospective Multicenter Randomized Comparative Study Between the U- and H-type Methods of the TVT SECUR Procedure for the Treatment of Female Stress Urinary Incontinence: 1-Year Follow-Up. Eur Urol 2010; 57:973-9. [PMID: 20206437 DOI: 10.1016/j.eururo.2010.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
|
35
|
JAIN A, KANNAN K, RANE A. Pelvic haematoma following Miniarc surgery - A case report. Aust N Z J Obstet Gynaecol 2010; 50:497-8. [DOI: 10.1111/j.1479-828x.2010.01165.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Joo YM, Choe JH, Seo JT. One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR(R) vs. CureMesh(R). Korean J Urol 2010; 51:337-43. [PMID: 20495697 PMCID: PMC2873888 DOI: 10.4111/kju.2010.51.5.337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 04/13/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures.
Collapse
Affiliation(s)
- Young Min Joo
- Department of Urology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
37
|
Nuestra experiencia con minicintas MiniArc® en la cirugía de la incontinencia urinaria de esfuerzo. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
38
|
Basu M, Duckett J. A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence. BJOG 2010; 117:730-5. [PMID: 20175874 DOI: 10.1111/j.1471-0528.2010.02513.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI). DESIGN Randomised trial. SETTING Urogynaecology unit in large UK district general hospital. POPULATION Women with USI resistant to conservative management and requiring a suburethral sling. METHODS A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies. MAIN OUTCOME MEASURES The presence of SUI at 6 weeks and 6 months after treatment. RESULTS The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8-32.6) and 6 months (OR 8.14, 95% CI 2.7-24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7-24.7). The rate of complication was similar in the two groups. CONCLUSIONS The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution.
Collapse
Affiliation(s)
- M Basu
- Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK.
| | | |
Collapse
|
39
|
MiniArc™ : étude prospective et suivi à un an d’une série de 72 patientes. ACTA ACUST UNITED AC 2010; 39:25-9. [DOI: 10.1016/j.jgyn.2009.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 10/20/2009] [Accepted: 10/26/2009] [Indexed: 11/20/2022]
|
40
|
Jiménez Calvo J, Hualde Alfaro A, Cebrian Lostal J, Álvarez Bandres S, Jiménez Parra J, Montesino Semper M, Raigoso Ortega O, Lozano Uruñuela F, Pinos Paul M, González de Garibay A. Stress urinary incontinence surgery with MiniArc® sling system: Our experience. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5786(10)70084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
41
|
Álvarez-Bandrés S, Hualde-Alfaro A, Jiménez-Calvo J, Cebrián-Lostal J, Jiménez-Parra J, García-García D, Montesino-Semper M. Complications of female urinary incontinence surgery with mini-sling system. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5786(10)70220-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|