MP38-16 COMPARISON OF OUTCOMES OF MINIARC AND MONARC SLINGS: UPDATE OF A SINGLE-CENTER SURGICAL SERIES

Abstract

INTRODUCTION AND OBJECTIVES: Previous studies showed that Single incision MiniArc slings are a safe procedure associated with high success and low complications rates. Furthermore, comparative studies, suggest that MiniArc and Monarc perform equally in the treatment of stress urinary incontinence (SUI). A pilot study conducted by our group confirmed similar results between MiniArc and Monarc. However, a larger population with a longer follow-up is needed to validate such results. In this context we aimed at assessing the rate of favourable outcomes and the rate of complications of MiniArc compared to Monarc slings in a large cohort of patients with a long follow up at a single tertiary referral center METHODS: The study includes 381 patients treated with primary sling for SUI between 2003 and 2012 at our center. Of them 166 (44%) underwent a MiniArc sling procedure, and 215 (56%) a Monarc procedure. All surgeons had adequate experience in sling surgery. The choice of sling was left at the discretion of the surgeon. All patients had complete data including age, history of diabetes mellitus (DM), BMI, presence of Mixed Urinary Incontinence (MUI). Postoperative outcomes were: persistent or recurrent stress incontinence rate (PoRSUI), surgical failure (SF) (i.e. need of second surgery for PoRSUI), subjective cure (SC), subjective improvement (SI), and no pads usage over 24 h (zero pad) rates. SC was defined as a negative response to the question “do you still experience any urinary leakage during activities?” while SI was considered in women who responded yes to the question “are you satisfied with the results?”. Finally we assessed post operative pain and erosion rates in both groups. Chisquare and Wilcoxon rank test were used to compare the outcomes between groups RESULTS: Mean follow up was 66 months (range 12-138). MiniArc and Monarc groups resulted homogeneous in terms of age, DM, BMI and MUI. The rate of PoRSUI in MiniArc and Monarc group was 6% and 13% respectively (p1⁄40.02). SF rate was 9% (n1⁄415) in MiniArc and 13% (n1⁄428) in Monarc patients (p1⁄40.22). SC, SI and no pads usage were 87%, 86%, 90% and 89%, 88%, 91% in MiniArc and Monarc respectively (all p>0.05), while post-operative pain and erosion rate were significantly higher in Monarc patients (14% vs 7% and 6% vs 0.6% respectively, all p<0.01) CONCLUSIONS: This study confirms the similar performance of both slings in terms of post-operative outcomes, with difference in erosion and pain rates, in a large cohort of patients with a longer follow up. Our results highlight, once again, the optimal outcomes of MiniArc not only in the short term but also with a mid-term follow-up