Abstract
ObjectiveTo evaluate the long-term outcomes of single-incision midurethral slings (SIMS) in real-life practice. Study DesignThis retrospective, single-arm, patient cohort study was performed in a large Dutch teaching hospital, including 397 consecutive women who underwent a SIMS-procedure between 2009 and 2018. Data were obtained through questionnaires and patient record study. Subjective improvement was the primary outcome, defined as a Patient Global Impression of Improvement (PGI-I) of ‘(very) much better’. Secondary outcomes were subjective cure rate (defined as a negative Urogenital Distress Inventory - item 4 ‘Do you experience involuntary urine leakage related to physical activity, coughing or sneezing?’), complication rate and sling failure (defined as the need for additional research or treatment for persisting stress urinary incontinence (SUI)). All data was analysed with a statistical significance level of 5%. ResultsThe mean follow-up time was 54 months. All patients received SIMS (Ajust® or Altis®). Of all respondents, 75% reported a (very) much improved burden of disease. The subjective cure rate was 61%. In 93 patients a total of 120 complications were registered. In 10% of patients a sling failure was observed, 76% of these failures appeared in the first two years post-surgery. ConclusionThis study showed that, in real life practice, SIMS are both effective and safe over a long period of time.
Highlights
Worldwide 6.1% of women suffer from stress urinary incontinence (SUI) [1].The first-line treatment of SUI is conservative management with pelvic floor therapy and lifestyle modifications, predominantly regarding weight reduction [2]
All consecutive patients who underwent a Singleincision midurethral slings (SIMS) procedure between November 1st 2009 and November 1st 2018 were included in this study
A total of 15 patients had received previous incontinence treatment before their SIMS surgery: one patient was treated with botulinum toxin injections, ten patients were previously treated with a bulking agent; nine of these with BulkamidÒ and one with UrolasticÒ, and four patients had received previous incontinence surgery; one was treated with a Retropubic mid-urethral sling (RMUS), one with a Transobturator mid-urethral slings (TMUS) and two patients were treated with a Burch colposuspension procedure
Summary
Worldwide 6.1% of women suffer from stress urinary incontinence (SUI) [1].The first-line treatment of SUI is conservative management with pelvic floor therapy and lifestyle modifications, predominantly regarding weight reduction [2]. Mid-urethral sling (MUS) procedures are considered the gold standard in the surgical treatment of SUI, if first line treatment is insufficient. ⇑ Corresponding author at: Isala, Department of Gynaecology, Dokter van tape (RMUS) with an efficacy of 92% It is associated with a risk of injury of the bladder, bowel and major vessels [3]. Transobturator mid-urethral slings (TMUS) have a lower risk of bladder injury, but are associated with thigh, groin and hip pain [3,4,5]. Singleincision midurethral slings (SIMS) have been available since 2006 [6] These slings do not perforate the adductor muscles, and are experienced by patients as a less painful procedure, but are as effective as TMUS in curing SUI [3]
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