1
|
Guillot-Tantay C, Van Kerrebroeck P, Chartier-Kastler E, Dechartres A, Tubach F. Long-term Safety of Synthetic Midurethral Sling Implantation for the Treatment of Stress Urinary Incontinence in Adult Women: A Systematic Review. EUR UROL SUPPL 2023; 54:10-19. [PMID: 37334402 PMCID: PMC10276216 DOI: 10.1016/j.euros.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/03/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Context Midurethral slings (MUSs) are the most used therapy for the treatment of stress urinary incontinence (SUI). While warning signals about potential complications have been raised worldwide, there is a lack of safety data especially in the long term. Objective Our objective was to evaluate synthetic MUS safety outcomes at long term in adult women. Evidence acquisition We included all studies evaluating MUSs in adult women with SUI. All synthetic MUSs have been considered: tension-free vaginal tape (TVT), transobturator tape (TOT), and mini-slings. The primary outcome was the reoperation rate at 5 yr. Evidence synthesis Of 5586 references screened after duplicate removal, 44 studies (8218 patients) were included. Among these, nine were randomized controlled trials and 35 were cohort studies. The overall reoperation rates at 5 yr varied between 0% and 19% for TOT (11 studies), 0% and 13% for TVT (17 studies), and 0% and 19% for mini-slings (two studies). The overall reoperation rates at 10 yr varied between 5% and 15% for TOT (four studies) and between 2% and 17% for TVT (four studies). There were few safety data beyond 5 yr: 22.7% of the articles reported a follow-up at ≥10 yr and 2.3% at ≥15 yr. Conclusions The incidence rates of reoperations and complications are heterogeneous, and data beyond 5 yr are rare. Patient summary There is an urgent need to improve safety monitoring of mesh as our review highlights that available safety data are heterogeneous and of insufficient quality to guide the decision.
Collapse
Affiliation(s)
- Cyrille Guillot-Tantay
- Hôpital Foch, Service d’Urologie, Suresnes, France
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | | | - Emmanuel Chartier-Kastler
- Sorbonne Université, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
- INSERM U1179 Handicap Neuromusculaire (UVSQ): Physiopathologie, Biothérapie et Pharmacologie appliquées, Equipe: Biothérapie & Pharmacologie des Dysfonctions Urogénito-sexuelles d’origine Neurologique, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Paris, France
| |
Collapse
|
2
|
Chao WT, Huang HY, Chen GY, Liu CH, Chan IS, Chang CP, Chen YJ, Wang PH, Horng HC. Efficacy and Safety of "I-stop-mini adjustable" Sling System Versus Transobturator Midurethral "Obtryx" Sling System in Stress Urinary Incontinence: A Retrospective Cohort Study. J Minim Invasive Gynecol 2021; 29:519-527. [PMID: 34902596 DOI: 10.1016/j.jmig.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To compare the safety, efficacy, and adverse events of the new mini-adjustable sling system "I-stop-mini" with transobturator midurethral slings "Obtryx" in women with stress urinary incontinence (SUI). DESIGN A single-center, retrospective cohort study. SETTING Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, Patients: Three hundred and forty-seven patients who underwent I-stop-mini or Obtryx for SUI treatment. INTERVENTION Mid-urethral sling with either I-stop-mini or Obtryx. MEASUREMENTS AND MAIN RESULTS The primary outcomes were objective success and subjective cure rates between the two groups. Objective success was evaluated using a one-hour pad test and subjective cure was evaluated using a questionnaire score (IIQ-7, UDI-6, ICIQ-SF). Secondary outcomes were the evaluation of surgical outcomes, operative data, and adverse events between the two groups. In total, 171 of 200 I-stop-mini subjects and 127 of 147 Obtryx subjects completed 12 months of follow-up. Regarding the objective success between the I-stop-mini group and the Obtryx group, 1 month postoperative (3.6±5.2 vs. 3.9±12.6; p = .765), post-operative 6 month (3.9±5.1 vs. 4.2±12.6; p = .848), 12 month (4.6±5.6 vs. 4.5±13.6; p = .980) one-hour pad tests showed no significant difference. The 12-month subjective cure rates decreased from 94.7% (1 month post-operative) to 91.2% (12 months post-operative) in the I-stop-mini group and 95.2% (1 month post-operative) to 85.0% (12 months post-operative) in the Obtryx group. Similar and durable efficacy was observed between the two groups. The I-stop-mini group had shorter operative times and hospital stays than the Obtryx group; however, both groups showed similar adverse event rates. CONCLUSION The objective success and subjective cure rates of I-stop-mini did not differ to those of Obtryx. However, long-term data and further prospective studies on I-stop-mini are necessary to arrive at a definite conclusion.
Collapse
Affiliation(s)
- Wei-Ting Chao
- Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Yi Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC
| | - Guan-Yeu Chen
- Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Hao Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-San Chan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Pei Chang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Huann-Cheng Horng
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
| |
Collapse
|
3
|
Fahrni AC, Betschart C, de la Jolinière JB, Dubuisson JB, Feki A, Major AL. A new titanium-covered transobturator tape for surgical treatment of stress urinary incontinence. Int Urogynecol J 2021; 33:911-918. [PMID: 34599671 PMCID: PMC9021133 DOI: 10.1007/s00192-021-04976-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/08/2021] [Indexed: 12/01/2022]
Abstract
Introduction and hypothesis To assess the long-term satisfaction, cure rate and safety of a new titanium-covered transobturator tape compared to polypropylene tape for the treatment of stress urinary incontinence (SUI). Methods A prospective study was conducted with 151 patients. Seventy patients underwent transobturator sling surgery with titanium tape from 2011 to 2019, and a historical control group (CG) of 81 patients was treated with a noncoated tape and underwent incontinence surgery from 1999 to 2009. We compared patient-reported outcome measures (PROMs) with the incontinence outcome questionnaire (IOQ). Results The median follow-up was 2½ years in both groups. Based on responses to the IOQ, a statistically significantly shorter time of recovery (IOQ 15: 21.3 ± 26.4 [TG], 40.2 ± 38.5 [CG], p = 0.02), improvement of sex life (IOQ 13: 34.1 ± 29.4 [TG] vs. 65.3 ± 35.6 [CG], p = 0.01) and less voiding dysfunction (IOQ 19: 30.9 ± 28.1 [CG], 9.3 ± 18.6 [TG], p = 0.01) were observed in the TG. Objectively, no postoperative urinary retention was observed in the TG, but four cases were described in the CG. Ten patients needed a reoperation for SUI in the CG compared to three in the TG (p = 0.03). Conclusion The titanium-covered transobturator sling had superior recovery time, improved sexual function and reduced reoperation rate compared to a historical polypropylene group.
Collapse
Affiliation(s)
- Anne-Claude Fahrni
- University & Department of Obstetrics and Gynecology, Cantonal Hospital, 1708, Fribourg, Fribourg, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zurich, University Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | | | - Jean-Bernard Dubuisson
- University & Department of Obstetrics and Gynecology, Cantonal Hospital, 1708, Fribourg, Fribourg, Switzerland
| | - Anis Feki
- University & Department of Obstetrics and Gynecology, Cantonal Hospital, 1708, Fribourg, Fribourg, Switzerland
| | - Attila Louis Major
- University & Department of Obstetrics and Gynecology, Cantonal Hospital, 1708, Fribourg, Fribourg, Switzerland. .,Femina Gynecology Center, Rue Emile-Yung 1, 1205, Geneva, Switzerland.
| |
Collapse
|
4
|
Baron M, Le Normand L, Paret F, Levesque A, Rigaud J, Perrouin-Verbe MA. Management of post-operative urinary incontinence after midurethral sling explantation for pelvic or perineal pain. Int Urogynecol J 2021. [PMID: 33822258 DOI: 10.1007/s00192-021-04759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to report the management of post-operative urinary incontinence after midurethral sling (MUS) revision for chronic pelvic pain (CPP), and to report functional outcomes. METHODS From November 2004 to February 2018, a total of 89 women who underwent removal or section of MUS for CPP, were enrolled. Patients were divided into the transobturator tape (TOT) group (50 patients) and the tension-free vaginal tape (TVT) group (37 patients); 2 patients had had both slings implanted. We report the rate of stress urinary incontinence (SUI) recurrence, the rate of de novo urge urinary incontinence (UUI), the need for subsequent SUI or UUI surgery, and functional outcomes (pain and continence). RESULTS Median follow-up was 41.4 months [0.9-138.8]. SUI recurrence or de novo UUI occurred in 52 cases (58.4%): 19 (51.3%) patients in the TVT group, 31 (62%) in the TOT group, and both patients (100%) who underwent total removal of both slings. Among patients with SUI recurrence or de novo UUI, 39 (75%) had pain relief after sling removal. Seventeen patients (32.6%) refused any treatment, 14 (26.9%) were cured with conservative therapy, and 21 (40.3%) underwent SUI or UUI surgery. One patient had de novo pelvic pain after reoperation. The overall continence rate for all patients who underwent sling revision was 82% (73 out of 89) at the last follow-up. CONCLUSION After MUS revision for CPP, post-operative UI may occur in 58.4% of patients, of which, one-fourth may be managed with conservative measures only. Forty percent of them had redo surgery with a low risk of pain recurrence and a high rate of urinary continence.
Collapse
|
5
|
Kim A, Kim S, Kim HG. Current Overview of Surgical Options for Female Stress Urinary Incontinence. Int Neurourol J 2020; 24:222-30. [PMID: 33017893 DOI: 10.5213/inj.2040052.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Stress urinary incontinence (SUI) is a highly prevalent health condition that significantly impacts the quality of life. Traditional methods of treatment for SUI, such as pubovaginal sling and Burch colposuspension, have been replaced by the midurethral sling because of its high efficacy, low complication and morbidity rates, and short learning curve. Although multiple behavioral and operative treatments exist, midurethral slings are the gold standard for the treatment of SUI in women. However, several reports have raised concerns about complications caused by the synthetic mesh used in midurethral slings. Therefore, surgical treatment for SUI in women must be chosen with care, taking into account potential complications. Herein, we review the current safety issues pertaining to the use of meshes, the efficacy of traditional surgeries, old and new midurethral slings, and recent data comparing the efficacy and safety of different surgical options. This review is aimed at developing practical guidelines for choosing surgical options for women with SUI.
Collapse
|
6
|
Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Kiesel L, Lambrinoudaki I, Hirschberg AL, Lopes P, Pines A, Rees M, van Trotsenburg M, Simoncini T. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas 2020; 143:223-230. [PMID: 33008675 DOI: 10.1016/j.maturitas.2020.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. AIM The aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS Healthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.
Collapse
Affiliation(s)
- Eleonora Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Johannes Bitzer
- Department of Obstetrics and Gynecology, University Hospital, Basel, Switzerland
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain
| | - Iuliana Ceausu
- Department of Obstetrics and Gynecology I, "Dr. I. Cantacuzino" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter Chedraui
- Instituto de Investigación e Innovación de Salud Integral (ISAIN), Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Fatih Durmusoglu
- İstanbul Medipol International School of Medicine, Istanbul, Turkey
| | - Risto Erkkola
- Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University of Münster, Münster, Germany
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Patrice Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain. F 44819 St Herblain France, Université de Nantes F, 44093, Nantes, Cedex, France
| | - Amos Pines
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Mick van Trotsenburg
- Department of Obstetrics and Gynecology, University Hospital St. Poelten, Lilienfeld, Austria
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
| |
Collapse
|
7
|
Yasa C, Dural O, Usta İ, Celik E, Salduz A, Gungor Ugurlucan F. Necrotizing Fasciitis Complicating Transobturator Tape Operation. Urol Int 2020; 104:657-660. [PMID: 32526742 DOI: 10.1159/000507942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/12/2020] [Indexed: 11/19/2022]
Abstract
Midurethral slings (MUSs) have been used successfully for the last 20 years in the treatment of stress urinary incontinence and accepted as the gold standard surgical procedure. High success rates and minimal invasiveness of surgery are among the most important advantages, but sometimes serious complications can occur during or after surgery. Although serious complications are rare after widely performed transobturator tape (TOT) operation, awareness, early diagnosis, and aggressive management are essential as they can progress with serious morbidity and mortality. In order to reduce the infectious complications after MUS procedures, in addition to sterility of the operating theater and the operating equipment, the type of mesh used and the preparation of the surgical site are crucial. We aimed to pre-sent the successful management of a case of necrotizing fasciitis in a TOT patient.
Collapse
Affiliation(s)
- Cenk Yasa
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey,
| | - Ozlem Dural
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - İrem Usta
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Engin Celik
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ahmet Salduz
- Department of Orthopedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| |
Collapse
|
8
|
Höfner K, Hampel C, Kirschner-Hermanns R, Alloussi SH, Bauer RM, Bross S, Bschleipfer T, Goepel M, Haferkamp A, Hüsch T, Kaufmann A, Kiss G, Kranz J, Oelke M, Pannek J, Reitz A, Rutkowski M, Schäfer W, Schulte-Baukloh H, Schumacher S, Seif C, Schultz-Lampel D. [Use of synthetic slings and mesh implants in the treatment of female stress urinary incontinence and prolapse : Statement of the Working Group on Urological Functional Diagnostics and Female Urology of the Academy of the German Society of Urology]. Urologe A 2020; 59:65-71. [PMID: 31741004 DOI: 10.1007/s00120-019-01074-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.
Collapse
Affiliation(s)
- K Höfner
- Urologische Klinik, Evangelisches Krankenhaus Oberhausen, Virchowstr. 20, 46047, Oberhausen, Deutschland.
| | - C Hampel
- Urologische Abteilung, Marien-Hospital Erwitte, Erwitte, Deutschland
| | - R Kirschner-Hermanns
- Neuro-Urologie/Urologie Universitätsklinikum Bonn und Neuro-Urologie, Neurologisches Rehabilitationszentrum der Godeshöhe e. V., Bonn, Deutschland
| | - S H Alloussi
- Abteilung Urologie, Universitätsspital Basel, Basel, Schweiz
| | - R M Bauer
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland
| | - S Bross
- Urologische Klinik, Fürst-Stirum-Klinik Bruchsal, Bruchsal, Deutschland
| | - T Bschleipfer
- Klinik für Urologie, Andrologie und Kinderurologie, Klinikum Weiden/Kliniken Nordoberpfalz AG, Weiden i. d. Oberpfalz, Deutschland
| | - M Goepel
- Klinik für Urologie und Nephrologie, Helios Klinikum Niederberg, Velbert, Deutschland
| | - A Haferkamp
- Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Hüsch
- Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Deutschland
| | - G Kiss
- Institution Neuro-Urologische Ambulanz, Univ. Klinik f. Urologie Innsbruck, Innsbruck, Österreich
| | - J Kranz
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie Eschweiler, Eschweiler, Deutschland
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - M Oelke
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, St. Antonius-Hospital Gronau, Gronau, Deutschland
| | - J Pannek
- Neuro-Urologie, Schweizer Paraplegiker-Zentrum Nottwil, Nottwil, Schweiz
- Urologische Klinik, Inselspital, Universitätsspital, Universität Bern, Bern, Schweiz
| | - A Reitz
- KontinenzZentrum Hirslanden Zürich, Zürich, Schweiz
| | - M Rutkowski
- Urologische Klinik, Landesklinikum Korneuburg, Korneuburg, Österreich
| | | | - H Schulte-Baukloh
- Urologie Turmstraße (Gemeinschaftspraxis), Berlin Mitte/Moabit, Deutschland
| | - S Schumacher
- Urology Department, Healthpoint Hospital, Abu Dhabi, Vereinigte Arabische Emirate
| | - C Seif
- Urologiezentrum Alter Markt, Kiel, Deutschland
| | - D Schultz-Lampel
- Kontinenzzentrum Südwest, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
| |
Collapse
|
9
|
Athanasiou S, Zacharakis D, Kalantzis C, Protopapas A, Chatzipapas I, Grigoriadis T. Women living with a midurethral sling in their 80s: long-term outcomes. Int Urogynecol J 2019; 31:2669-2674. [PMID: 31828402 DOI: 10.1007/s00192-019-04174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical outcomes of elderly women who have been treated using midurethral slings could be influenced by confounding factors, such as age-related comorbidities. Aim of this study is to assess elderly patients (>75 years) who underwent a transobturator sling procedure with a follow-up of at least 13 years. METHODS This is a prospective follow-up observational study including elderly women of current age ≥ 75 years old who underwent TVT-O placement at least 13 years prior to the study period. Main outcome measures were the objective and subjective cure rates at the follow-up visit. Secondary outcome measures included: patient-reported success rate, de novo urgency symptoms rate, evaluation of other subjective parameters related to the lower urinary tract function, and assessment of the health-related quality of life. RESULTS Seventy-two out of 85 women (84.7%) meeting the inclusion and exclusion criteria were assessed at the follow-up visit. The mean follow-up period was 13.7 years (SD = 0.8). The overall objective and subjective cure rates were 80.5% (58 out of 72) and 84.7% (61 out of 72) respectively, whereas 9.7% of the patients (7 out of 72) reported being subjectively improved. The patient-reported success rate was 91.7% (66 out of 72). De novo urgency rate was 23.7% (9 out of 38), whereas 26.5% of the patients (9 out of 34) reported aggravation of preexisting urgency. CONCLUSIONS In women of advanced age, the TVT-O procedure is a highly effective and long-lasting treatment. The safety profile of the TVT-O was not influenced by geriatric conditions, whereas the long-term presence of a polypropylene sling did not appear to trigger the onset of medical disorders.
Collapse
Affiliation(s)
- Stavros Athanasiou
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece.
| | - Dimitrios Zacharakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Christos Kalantzis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Athanasios Protopapas
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Ioannis Chatzipapas
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Themos Grigoriadis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| |
Collapse
|
10
|
Schiøtz HA, Svenningsen R, Kulseng-Hanssen S. Comparison of retropubic midurethral slings in the treatment of female stress urinary incontinence. Int Urogynecol J 2020; 31:711-6. [PMID: 31410521 DOI: 10.1007/s00192-019-04080-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Over 50 different types of midurethral slings have been marketed. They have generally been considered comparable in performance. Many studies have compared retropubic with obturator slings, but few have compared different makes of retropubic slings with each other. We have compared the performance of retropubic slings using data from the Norwegian Female Incontinence Registry. METHODS From June 2015 through 2017, 2843 women underwent a retropubic sling procedure, with 6-12-month follow-up data available for 2612 (92%). Results for six different types of slings used in this time period are presented: TVT Exact, TVT Classic, Advantage, Advantage Fit, TVT A.M.I. and RetroArc. The TVT Exact was the most prevalent sling, and the outcomes were compared with this sling as reference using chi-square and Dunnet's tests with significance at 0.05. RESULTS There were only small differences among the four slings, TVT Exact, TVT Classic, Advantage and Advantage Fit, with subjective cure rates from 77.7 to 81.9% and objective cure rates from 90.8 to 96.6%. The TVT A.M.I. sling had a high cure rate but significantly fewer satisfied patients and less improvement in urgency bother. The Retro Arc's results were clearly inferior. There was little difference in terms of obstruction or de novo urgency incontinence among the six slings. Most complication rates were not statistically different. CONCLUSIONS At 6-12-month follow-up there was no significant difference in clinical results between the TVT Exact, TVT Classic, Advantage and Advantage Fit slings, while RetroArc and to some extent TVT A.M.I. slings underperformed.
Collapse
|
11
|
Alas A, Martin L, Devakumar H, Frank L, Vaish S, Chandrasekaran N, Davila GW, Hurtado E. Anesthetics' role in postoperative urinary retention after pelvic organ prolapse surgery with concomitant midurethral slings: a randomized clinical trial. Int Urogynecol J 2020; 31:205-13. [PMID: 30904934 DOI: 10.1007/s00192-019-03917-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Spinal anesthesia can be a potential risk factor for postoperative urinary retention (POUR). Our objective was to compare POUR rates for outpatient vaginal pelvic floor surgeries when using spinal versus general anesthesia. Our hypothesis was that spinal anesthesia would have higher POUR rates compared with general anesthesia. METHODS This was a randomized clinical trial on subjects undergoing outpatient pelvic organ prolapse (POP) surgery with a concomitant midurethral sling (MUS). Subjects were discharged home the same day as surgery. Subjects were excluded if they had a preoperative post-void residual > 150 ml, they were < 40 years of age, surgery was < 1 h, or they had contraindications to spinal or general anesthesia. A standardized voiding trial was performed. The primary aim was to compare POUR rates between anesthesia groups. A power analysis estimated 28 subjects were required per group to detect a 37% difference with 80% power and an alpha of 0.05. RESULTS The trial was registered at ClinicalTrials.gov on July 15, 2015. Sixty-one subjects were enrolled between June 22, 2015, and December 31, 2017. Three were excluded, leaving 29 in each group. Groups were similar in demographics. For the primary outcome, there was a 14.3% difference in POUR rates between spinal and general anesthesia, which did not reach statistical significance based on our power calculation (p = 0.2516). CONCLUSIONS Based on this study, there is not an increased rate of POUR with the use of spinal anesthesia for POP surgery with MUS. However, since there was a trend toward higher rates of POUR in the spinal group, it is possible that a larger powered study design would be able to detect a statistically significant difference between the groups. Based on these findings, if surgical patients would benefit from spinal anesthesia, the risk of urinary retention should not be considered a reason to not utilize this form of anesthesia. CLINICAL TRIAL REGISTRATION Does spinal anesthesia for prolapse surgery with concomitant sling lead to an increase in urinary retention compared to general anesthesia? https://clinicaltrials.gov/ct2/show/NCT02547155?term=laura+martin&rank=3 (NCT02547155).
Collapse
|
12
|
Hansen MF, Lose G, Sigurdardòttir HB, Gradel KO. A Danish national population-based cohort study of synthetic midurethral slings, 2007-2011. Int Urogynecol J 2019; 30:733-41. [PMID: 30073484 DOI: 10.1007/s00192-018-3719-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Synthetic midurethral slings (MUSs) have shown similar cure rates in several short- and medium-term follow-up studies. Recently, long-term follow-up studies have indicated that the cure rate is higher following the retropubic midurethral sling (RPMUS) compared with the transobturator midurethral sling (TOMUS) procedure. The aim was to evaluate the efficacy of synthetic MUSs and to examine the influence of department and surgeon volume and patient-related factors on the cure rate of synthetic MUSs. METHODS A retrospective cohort study based on a national population over a 5-year period (2007-2011) using data from the Danish Urogynaecological Database (DugaBase). RESULTS A total of 4519 women with first-time MUS were registered in the DugaBase. Cure was achieved in 1242/1639 (75.78%) at a 3-month follow-up. RPMUSs were more frequently in use in high-volume departments compared with the other departments and more often implanted by high- than low-volume surgeons. Women treated by a medium- (adjusted OR 1.82; 95% CI 1.01-3.28, "frequency") or high-volume surgeon (1.98; 1.18-3.32, "frequency") had an increased probability of cure compared with women treated by a low-volume surgeon. The difference was only significant for women who received a TOMUS. CONCLUSIONS This national population-based cohort study confirmed a high cure rate of synthetic MUSs at short-term follow-up. It is the largest study to indicate a learning curve for TOMUS. Patients were not actively involved in which synthetic MUS was to be performed as the choice of surgical option was made at the departmental level.
Collapse
|
13
|
Melon J, Kelly EC, van Delft KWM. Cystourethroscopy following midurethral slings: is it always necessary? Int Urogynecol J 2018; 29:789-793. [PMID: 29564509 DOI: 10.1007/s00192-018-3611-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Abstract
Midurethral slings are the mainstay of treatment for stress urinary incontinence. The role of cystourethroscopy to detect lower urinary tract injury following retropubic midurethral slings is well-established; however, its role following transobturator or single-incision sling placement remains controversial. Some advocate "routine" whereas others advocate for "selective" cystourethroscopy. This paper reviews the arguments for and against cystourethroscopy to detect lower urinary tract injury following transobturator and single-incision slings.
Collapse
Affiliation(s)
- Jerome Melon
- Pelvic Floor Unit, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - Erin C Kelly
- Department of Obstetrics and Gynecology, London Health Sciences Centre, Victoria Campus, Western University, Room B2 401, 800 Commissioners Road East, London, ON, N6H 5W9, Canada
| | - Kim W M van Delft
- Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10 (route 791), Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
14
|
Xia Z, Qian J, Chen Y, Liao B, Luo D. Does body mass index influence the outcome of midurethral sling procedures for stress urinary incontinence? Int Urogynecol J 2017; 28:817-22. [PMID: 27822886 DOI: 10.1007/s00192-016-3181-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/28/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Whether midurethral sling (MUS) procedures are as effective in obese women as they are in women of normal weight is still a matter of controversy. The objective of this study was to determine if body mass index (BMI) influences the outcome of MUS procedures for stress urinary incontinence (SUI). METHODS We searched electronic databases including EMBASE, MEDLINE, Web of Science and Ovid evidence-based medicine reviews to identify studies that explored the association between BMI and outcomes of MUS procedures. The studies were rated using the Newcastle-Ottawa scale; the meta-analysis was performed using Review Manager 5.3 software. RESULTS This review included 11 studies, 6 prospective cohort studies and 5 retrospective studies, with a total of 2,846 patients. The objective success rates of MUS in patients with BMI >25 kg/m2 (overweight and obese) were lower than in patients with BMI 18.5 - <25 kg/m2 (normal weight; RR = 0.93, 95 % CI 0.89 - 0.97; P = 0.002). The objective success rates were not significantly different between the overweight group (BMI 25 - <30 kg/m2) and the obese group (BMI ≥30 kg/m2; RR = 0.95, 95 % CI 0.89 - 1.01; P = 0.08). There were no significant differences in subjective outcomes among the different BMI groups: BMI ≥25 kg/m2 versus 18.5 - <25 kg/m2 (RR = 1.03, 95 % CI 0.97 - 1.10; P = 0.29), and BMI ≥30 kg/m2 versus 25 - <30 kg/m2 (RR = 0.98, 95 % CI 0.92 - 1.04; P = 0.55). CONCLUSIONS The objective success rates of MUS were lower in overweight and obese patients; however, the subjective outcomes of MUS were not significantly different among normal weight, overweight and obese patients. The MUS procedure is as effective in obese women as in women of normal weight, and therefore surgeons should not consider BMI >25 kg/m2 as a risk factor when discussing the suitability of the MUS procedure in a patient with SUI.
Collapse
|
15
|
Alas A, Chinthakanan O, Espaillat L, Plowright L, Aguilar V, Davila GW. Are suburethral slings less successful in the elderly? Int Urogynecol J 2016; 28:553-559. [PMID: 27629119 DOI: 10.1007/s00192-016-3132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to evaluate the success of suburethral slings in women ≥70 years of age. METHODS This was a retrospective cohort study of women who underwent suburethral sling placement. Subjects were separated into three groups: ≤50 years of age (group 1), 51 to 69 years of age (group 2), and ≥70 years of age (group 3). The primary aim was to evaluate success as defined by ≥ improved on a validated patient improvement satisfaction score and a negative postoperative standardized stress test. RESULTS There were 1,464 subjects. Mean age was 44.51 ± 4.25 (n = 296) for group 1, 60.5 ± 5.28 (n = 680) for group 2, and 77.68 ± 5.41 (n = 488) for group 3. The median follow-up was 26 (6-498) weeks, 45 (6-498) weeks, and 42 (6-543) weeks, for groups 1, 2, and 3 respectively. Multiple logistic regression analysis demonstrated no difference in sling success according to age stratification. Lower success was associated with having had a previous sling (adjusted OR 0.25, 95 % CI 0.12-0.5), having detrusor overactivity (adjusted OR 0.44, 95 % CI 0.28-0.69), and having a history of urge urinary incontinence (UUI) for ≥ 4 years (adjusted OR 0.54, 95 % CI 0.31-0.95). CONCLUSIONS There is no difference in sling success between the elderly and younger populations. However, those with previous sling surgery or a long standing history of UUI may be at a higher risk of failure.
Collapse
Affiliation(s)
- Alexandriah Alas
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Orawee Chinthakanan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Luis Espaillat
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Leon Plowright
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Vivian Aguilar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - G Willy Davila
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
| |
Collapse
|
16
|
Vij M, Dua A, Freeman RM. Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? A time to revisit. Int Urogynecol J 2016; 27:1491-5. [PMID: 27010558 DOI: 10.1007/s00192-016-3007-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Maximum urethral closure pressure (MUCP) provides an objective assessment of urethral integrity, but its role in predicting outcome after midurethral sling (MUS) placement is debatable and current practice in the UK is variable. The study was carried out to determine if lower preoperative MUCP is associated with poor outcome following MUS. METHOD The study was a retrospective review of the British Society of Urogynaecology (BSUG) database and urodynamics (UDS) data. Patients who reported outcome as "no improvement", "worse" or "much worse" on the Patient Global Impression of Improvement (PGII) scale were identified as having a poor outcome. Patients who reported "a little improvement", "improved" and "very much improved" on the PGII were thought to have a good outcome. The preoperative demographics, UDS findings and quality of life (International Consultation of Incontinence questionnaires [ICIQ-SF]) data of the two groups were compared. RESULT A total of 236 women were identified for the study. Of these, 24 women (10.2 %) had a poor outcome. Of the remaining women reporting a good outcome, 50 cases were randomly selected. All urodynamic parameters, including mean functional urethral length (FUL), bladder capacity, and Qmax, were similar, except for mean MUCP 37.05 cm H2O, which was significantly lower in group 1 (poor outcome 37.05 cm H2O) compared with a mean MUCP of 50.6 cm H2O in group 2 (good outcome; p = 0.005). CONCLUSION We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure.
Collapse
|
17
|
Schellart RP, Oude Rengerink K, Van der Aa F, Lucot JP, Kimpe B, de Ridder DJMK, Dijkgraaf MGW, Roovers JPWR. A randomized comparison of a single-incision midurethral sling and a transobturator midurethral sling in women with stress urinary incontinence: results of 12-mo follow-up. Eur Urol 2014; 66:1179-85. [PMID: 25168619 DOI: 10.1016/j.eururo.2014.07.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/21/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Midurethral sling procedures have become the prime surgical treatment for women with stress urinary incontinence (SUI). Single-incision mini-slings (SIMS) potentially offer similar efficacy with reduced morbidity. This international multicenter trial compared the efficacy and morbidity of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS) (Monarc). OBJECTIVE To compare subjective and objective cure, morbidity, and surgery-related discomfort following SIMS and transobturator SMUS. DESIGN, SETTING, AND PARTICIPANTS Prospective randomized controlled trial with an initial follow-up period of 12 mo. Women with symptomatic SUI were eligible. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was subjective cure, defined as an improvement on the Patient Global Impression of Improvement (PGI-I). Coprimary outcome was the mean visual analog scale (VAS) pain score (0-100) during 3 d after surgery. Secondary outcomes were objective cure based on the cough stress test (CST), disease-specific quality of life determined by the Urogenital Distress Inventory (UDI-6) score, surgical parameters, and physical performance during recovery. Analysis was by intent to treat. Differences between the MiniArc and Monarc groups on dichotomous variables were chi-square tested and presented as relative risks (RR) with corresponding 95% confidence intervals. We hypothesized that MiniArc was noninferior to Monarc concerning subjective cure and superior concerning postoperative pain. RESULTS AND LIMITATIONS We randomized 97 women to MiniArc and 96 to Monarc. At 12-mo follow-up, subjective cure was 83% following MiniArc and 86% following Monarc (p=0.46). Objective cure was 89% following MiniArc and 91% following Monarc (p=0.65). The mean pain VAS score during the first three postoperative days was 9 following MiniArc and 22 following Monarc (Mann-Whitney U test, p<0.01). CONCLUSIONS At 1-yr follow-up, MiniArc was noninferior to Monarc with respect to subjective and objective cure and superior with respect to postoperative pain. PATIENT SUMMARY This 1-yr randomized clinical trial showed that MiniArc, a single-incision midurethral sling, is noninferior to Monarc, a transobturator sling, with respect to cure and superior with respect to pain and recovery.
Collapse
Affiliation(s)
- René P Schellart
- Department of Obstetrics and Gynecology, Kennemer Gasthuis, Haarlem, The Netherlands.
| | - Katrien Oude Rengerink
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Philippe Lucot
- Department of Obstetrics and Gynecology, Jeanne de Flandre Hôpital, Lille Cedex, France
| | - Bart Kimpe
- Department of Urology, General Hospital Sint Lucas, Bruges, Belgium
| | | | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Abstract
Stress urinary incontinence is a prevalent condition that significantly impairs the quality of life. This article presents a critical summary of the current literature on the use and value of urodynamic studies in the evaluation of stress urinary incontinence in women.
Collapse
Affiliation(s)
- Lysanne Campeau
- Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1E2, Canada.
| |
Collapse
|
19
|
Han EJ, Kim SR, Kim SK, Bai SW. Comparison of midurethral sling outcomes with and without concomitant prolapse repair. Obstet Gynecol Sci 2014; 57:50-8. [PMID: 24596818 DOI: 10.5468/ogs.2014.57.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/22/2013] [Accepted: 09/12/2013] [Indexed: 11/10/2022] Open
Abstract
Objective We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair. Methods We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis. Results We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970). Conclusion The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.
Collapse
|
20
|
The Trial of Mid-Urethral Slings (TOMUS): Design and Methodology. J Appl Res 2008; 8:AlboVol8No1. [PMID: 24772006 PMCID: PMC3999832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Mid-urethral slings (MUS) are increasingly common surgical procedures for the treatment of stress urinary incontinence (SUI) in women. There are currently no adequately powered trials with sufficient length of follow-up comparing the efficacy or safety of the transobturator and retropubic MUS. As a result, no selection criteria are available to guide surgeons or patients. This article describes the methodology and rationale for the Trial Of Mid-Urethral Slings (TOMUS). PATIENTS AND METHODS The primary aims of this randomized controlled trial is to compare subjective and objective success rates for urinary incontinence (UI) at 12 and 24 months following retropubic and transobturator MUS procedures. Secondary aims are to compare the resolution of overall and stress-specific UI, morbidity, the time to adequate voiding, satisfaction, and quality of life in the two groups. TOMUS will also assess the clinical utility of pre-operative urodynamics in women undergoing MUS procedures. The primary outcome will be obtained at 12 months and 24 months. The definition of treatment success is two-fold. Objective treatment success is defined by a negative stress test, a negative 24-hour pad test and no retreatment for SUI. Subjective treatment success is defined by no self-reported leakage on 3-day diary and no self-reported SUI symptoms. Enrollment began April 2006 and is expected to be complete in 2 years. CONCLUSIONS The TOMUS trial is designed to provide outcome and safety information to pelvic surgeons and their patients on the two most commonly performed MUS techniques.
Collapse
|