Editorial Comment

Abstract

The authors report on a prospective, longitudinal cohort study of women undergoing Miniarc for the treatment of stress urinary incontinence. The premise behind the Miniarc and other “minislings” is that they should have similar efficacy and be associated with lower morbidity compared with traditional midurethral slings. In the case of the Miniarc, the comparator would be the transobturator midurethral slings. The authors report a subjective cure rate of 93.5% at 1 year, with 10% of patients lost to follow-up. If one considers the extremes of all lost-to-follow-up patients as all failed or all cured, the range is from 84% to 94%. This certainly compares favorably with subjective cure rates for other midurethral slings. However, looking more critically at the study design, I do not believe that one can say with certainty that the efficacy is comparable (although it certainly may be). I would have preferred to see more stringent, validated questions regarding subjective cure and improvement. “Direct questioning,” which can be a little different each time the question is asked, is not the best way to assess outcome. Also, validated global questions regarding overall improvement are helpful in these types of studies. Finally, some objective measures of success would be nice. Single Incision Mid-urethral Sling for Treatment of Female Stress Urinary IncontinenceUrologyVol. 77Issue 2PreviewTo present the longitudinal outcomes in an observational cohort of patients who had undergone treatment of stress urinary incontinence with a single incision mid-urethral sling (MUS). Full-Text PDF ReplyUrologyVol. 77Issue 2PreviewWe appreciate the reviewer's insight and sage commentary. Our study was designed specifically to address the early experiential outcomes with the MiniArc midurethral sling and was not meant to address its equivalence or superiority compared with the TVT-O or TVT. Certainly, a large, multicenter, randomized, controlled trial is needed to fully address these questions. Whether such a trial could be satisfactorily completed before the sling and/or technique is rendered obsolete by future slings or techniques remains speculative. Full-Text PDF