Midurethral Polypropylene Sling Research Articles

Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh.

To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer. We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression. The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3-0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5-1.2), endometrial (HR 1.1, 95% CI 0.8-1.4), cervical (HR 0.4, 95% CI 0.2-1.0), bladder, and urethra (HR 0.7, 95% CI 0.4-1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7-0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3-29.5) vs 21.0 (20.6-21.5) for rectal cancer, 25.5 (18.4-35.3) vs 19.8 (19.4-20.2) for ovarian cancer, 65.0 (53.0-79.8) vs 33.1 (32.6-33.7) for endometrial cancer, 5.7 (2.8-11.3) vs 11.9 (11.6-12.2) for cervical cancer, and 19.1 (13.1-27.8) vs 13.3 (13.0-13.7) for bladder and urethra cancer. Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.

Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery.

The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period. During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25-30, 16.9% had BMI 30-35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2years of follow-up was 1.9% (CI 95%: 1.6-2.3) and after 5years 2.4% (CI 95%: 2.0-2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2years of follow-up was 3.2% (CI 95%: 1.6-6.2) for women with BMI >35 and after 5years 4.0% (CI 95%: 2.0-7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89-3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92-4.09). We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.

Bioerosion of Synthetic Sling Explants.

This study was performed to investigate the changes over time in polypropylene (PP) mesh explants from women with stress urinary incontinence originally treated with a midurethral PP sling. Following Institutional Review Board (IRB) approval, 10 PP explants removed for pain or obstructive symptoms between January and June 2016 were analyzed through various techniques to determine the degradation of the material in vivo. Exclusion criteria were exposed or infected mesh sling or sling in place for less than six months. One pristine control was studied for comparison. The explant samples were analyzed with scanning electron microscopy to visualize the surface defects as well as infrared spectroscopy and energy dispersive X-ray spectroscopy to determine if the degradation was oxidative in nature. The results show qualitative and quantitative bioerosion over the surface of the explant samples and an increase in the content of oxygen pointing toward oxidative degradation occurring in vivo.

Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence

Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women. A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms "Stress urinary incontinence", "Overweight", "Obesity" and "Surgery". We included 13 full-text papers published from January 1995 to May 2014. We defined two groups of women: non-obese (BMI below 30 kg/m(2)) and obese (BMI above 30 kg/m(2)). Data regarding subjective and objective cure and selected perioperative complications were pooled and compared. The pooled data from the 13 studies showed that 76.4% and 74.7% of non-obese and obese women, respectively, were subjectively cured (p = 0.70), and 83.3% and 79.2%, respectively, were objectively cured (p = 0.56). Bladder perforation was more frequently reported in non-obese women (p < 0.01). We did not detect a significant difference in postoperative urine retention or sling excision between the two groups (p = 0.36 and p = 0.17, respectively). Cure rates were found to be comparable in obese and non-obese women. Perioperative complications were not reported to occur more often in obese women. The outcomes of sling procedures for SUI appear to be comparable in obese and non-obese women, and counselling of obese women regarding outcomes and perioperative complications can be similar.

Late Bladder Erosion Complications and Vesical Stone Formations of Synthetic Graft Materials Used in Mid-Urethral Sling Procedures

We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings.

History and Future of Multi-Institutional Clinical Trials in Urinary Incontinence

History and Future of Multi-Institutional Clinical Trials in Urinary Incontinence

Laparoendoscopic single-site transvesical removal of mid-urethral polypropylene sling eroded into the bladder

Complications of mid-urethral sling procedure such as erosion into the bladder are not very common. However, when they occur, removal of the tape may be necessary. To date, this complication has usually been managed by retropubic exploration or operative cystoscopy, which can often be associated with disproportionate morbidity or even failure. We present 2 cases of a laparoendoscopic single-site surgery (LESS) approach for removal of polypropylene tape eroded into the bladder. We report two female patients aged 41 years and 47 years who underwent treatment with this novel technique. A TriPort® single-site access system was placed through the apex of the bladder under cystoscopic control. Carbon dioxide was used for insufflations of the bladder. A combination of straight and articulating laparoscopic instruments was used to dissect and completely remove the foreign body. Both patients were managed adequately in the manner presented above. The length of the skin incision was 20 mm. Time of intervention was 35 min and 40 min. No blood loss or complications occurred. A Foley 18 F catheter was left for seven days and the patients were discharged on the 1 st postoperative day. The follow-up period (4 months and 7 months) showed no events related to the method. Removal of foreign bodies of the bladder through a single transvesical laparoscopic port is technically feasible. This procedure offers excellent visualization inside the bladder, especially near the bladder neck where polypropylene tapes often reside, and provides patients with a minimally invasive approach through a single small incision.

1775 DURABLE LONG-TERM IMPROVEMENTS IN CONTINENCE WITH THE USE OF RETROPUBIC MID-URETHRAL POLYPROPYLENE SLING

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20101775 DURABLE LONG-TERM IMPROVEMENTS IN CONTINENCE WITH THE USE OF RETROPUBIC MID-URETHRAL POLYPROPYLENE SLING Jason Kim, Alvaro Lucioni, Fred Govier, and Kathleen Kobashi Jason KimJason Kim More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Fred GovierFred Govier More articles by this author , and Kathleen KobashiKathleen Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1685AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The efficacy of retropubic mid-urethral polypropylene slings (MUS) has been previously shown. However, long term data has been lacking. We examined our series of MUS to determine long-term continence, improvement and, patient satisfaction rates and compare these results with a cohort of patients with shorter-term follow-up. METHODS A retrospective review of prospectively collected data of all patients undergoing placement of MUS with minimum 1 year follow-up was performed. Each patient was mailed a post-operative questionnaire to assess outcomes. We compared patients with follow-up ¡Ý60 months to those with follow-up <60 months. Outcomes included patient-perceived improvement, satisfaction and degree of post-operative stress urinary incontinence (SUI). We defined success as <1 incontinence episode/week or ¡Ý70% improvement RESULTS A total of 237 of 346 patients who underwent placement of MUS were at least one year post-op and had answered follow-up questionnaires. Outcomes of the entire population are seen in table 1. The average follow-up was 45 months. 161 patients had follow-up between 12 and 60 months (group 1), while 76 patients had follow-up ¡Ý60 months (group 2). The average follow-up times for group 1 and 2 were 33.6 and 67 months, respectively and were significantly different (p<0.00001). Outcomes comparing these 2 groups are listed in table 1. Degree of SUI, patient-perceived improvement, satisfaction, and success rates were quite similar between the 2 groups and not significantly different. CONCLUSIONS Our data show that placement of retropubic MUS are quite efficacious even with extended follow-up. The results suggest that outcomes do not significantly worsen over time. Seattle, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e687 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Kim More articles by this author Alvaro Lucioni More articles by this author Fred Govier More articles by this author Kathleen Kobashi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1768 CONCOMITANT PELVIC ORGAN PROLAPSE SURGERY DOES NOT AFFECT OUTCOMES OF RETROPUBIC MID-URETHRAL POLYPROPYLENE SLINGS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20101768 CONCOMITANT PELVIC ORGAN PROLAPSE SURGERY DOES NOT AFFECT OUTCOMES OF RETROPUBIC MID-URETHRAL POLYPROPYLENE SLINGS Jason Kim, Alvaro Lucioni, Fred Govier, and Kathleen Kobashi Jason KimJason Kim More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Fred GovierFred Govier More articles by this author , and Kathleen KobashiKathleen Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1678AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Past studies have suggested that outcomes of mid-urethral polypropylene (MUS) slings are adversely affected by concomitant surgery for pelvic organ prolapse (POP). We analyze our series of retropubic (RMUS) to determine if outcomes are affected by performing concomitant surgery to correct POP. METHODS A retrospective review of prospectively collected data was performed to determine surgical outcomes for all patients undergoing RMUS between October 2001 and August 2008. Each patient was mailed a post-operative questionnaire to assess outcome. We compared questionnaire results of patients undergoing RMUS alone to those who had RMUS and concomitant POP surgery. Our definition of success was either <1 incontinent episode/week or perceived improvement >70%. The Baden-Walker system was used to grade cystoceles and rectoceles. Rectocele repair was only carried out in symptomatic patients. RESULTS Our response rate for post-operative questionnaires was 83.9%. We only selected the 235 patients that had at least one year follow-up. Concomitant POP surgery was performed in 52.8% of the patients; 32.1% had cystocele repair, 25.7% had rectocele repair, 0.013% had sacrocolpopexy, and 0.009% had enterocele repair. The success rate of RMUS while undergoing any concomitant surgery was exactly the same (80.9%) as the cohort that did not undergo POP repair (p=0.82). In those patient who underwent cystocele repair and RMUS, the success rate was 81.4%, compared to 79.7% for those patients undergoing RMUS alone (p=0.77). The average grade of cystocele was 2.16 in those undergoing repair, compared to 0.85 in those undergoing RMUS alone (p<0.00001). Those undergoing rectocele repair and RMUS had a success rate of 76.9%, while the success rate of those undergoing RMUS alone was 81.5% (p=0.45). The average grade of rectocele in those undergoing repair was 1.50, compared to 0.81 in the patients not undergoing rectocele repair (p<0.00001). We did not have enough patients undergoing sacrocolpopexy or enterocele to individually evaluate the effect of outcomes of RMUS. CONCLUSIONS Contrary to previously reported results, we clearly demonstrate that performing concomitant POP surgery during RMUS placement does not affect outcomes. Seattle, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e684-e685 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Kim More articles by this author Alvaro Lucioni More articles by this author Fred Govier More articles by this author Kathleen Kobashi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Oral Presentation 3

OBJECTIVES: The purpose of this study was to determine risk factors for voiding dysfunction necessitating sling revision after midurethral polypropylene sling placement. MATERIALS AND METHODS: This multicenter case-control study included patients who underwent midurethral polypropylene sling placement and subsequent sling revision secondary to voiding dysfunction from January 1999 to January 2007 from nine urogynecologic centers across the US. Controls were patients who had undergone midurethral polypropylene sling placement not necessitating revision and were matched by patient age and date of surgery. Data collected included demographics, urodynamic study data, sling type, operative data, and clinical information before and after sling revision. Univariate analyses identified risk factors for voiding dysfunction, based on chi square tests for categorical variables, independent samples t-tests for normally distributed continuous variables, and Mann-Whitney rank sums tests for non-normally distributed continuous variables. Direct logistic regression analysis was used to determine which diagnostic variables predicted voiding dysfunction necessitating sling revision. RESULTS: One hundred ninety seven patients met case study criteria with 2 controls matched to each case for a total of 394 controls. Two hundred fourteen patients had all data points and were included in the logistic regression analysis. No specific patient characteristics increased the risk for sling revision including: age, race, BMI, smoking status, menopause status, hormone use, COPD/asthma history, previous incontinence or prolapse surgery, prior hysterectomy, preoperative diagnosis, and presence of intrinsic sphincter deficiency. Risk factors for sling revision did include: retropubic sling type (OR = 2.11, 95% CI 1.03–4.34, P = .04) and concurrent surgery (OR = 4.21, 95% CI 1.96–9.04, P = .0002) In contrast, pre-sling post void residual values, maximum detrusor pressures, maximum urinary flow rates, general anesthesia, and sling tensioning with cough/crede versus visual placement did not significantly predict the need for sling revision (all P-values >.05). CONCLUSION: This study determined that the retropubic sling type and concurrent surgery at the time of sling placement are risk factors for postoperative voiding dysfunction and sling revision. Urodynamic findings, baseline demographic information, anesthesia type and sling tensioning technique were not found to be predictive of voiding dysfunction and need for sling revision.

Emerging technologies to treat female stress urinary incontinence

In the past decade, retropubic and transobturator, midurethral polypropylene slings have become the most commonly performed procedures to treat female stress urinary incontinence, virtually replacing traditional open procedures. Despite low morbidity rates, major reported complications have spawned a new generation of midurethral slings that claim increased patient safety. This article discusses the three most popular new devices, highlighting key differences in design and surgical technique, as well as available outcomes data.

Vaginal erosion after hybrid midurethral sling placement

Midurethral polypropylene slings are popular procedures for the treatment of stress urinary incontinence in women. Several commercially manufactured sling kits are available that use proprietary monofilament polypropylene mesh placed between the vaginal wall and midurethral segment. The BioArc sling system is a hybrid sling system that uses polypropylene mesh for fixation and autologous fascia for suburethral support. We report what we believe to be the first case of vaginal erosion after midurethral sling placement using this hybrid system.

Delayed urethral erosion after tension-free vaginal tape

Urethral erosions have been reported with various sling materials placed by means of various techniques. The patient often presents in the immediate postoperative period, although late presentations have been described. The diagnosis is made on cystoscopy, and mesh excision with urethral reconstruction is advocated. We present the cases of two patients with urethral erosion after mid-urethral polypropylene sling who presented 3 months after surgery with urethral pain, mid-urethral blockage and symptoms of bladder dysfunction. Urethroscopy revealed the mesh bridging the lumen of the urethra. Trans-vaginal mesh excision and layered urethral reconstruction was curative in both patients.

Suburethral sling using the transobturator approach: A quality-of-life analysis

The objective of the study was to determine the degree of benefit of a transobturator midurethral polypropylene sling in patients with stress urinary incontinence through a quality-of-life instrument and outcome analysis. Forty-seven patients completed the validated Individual Incontinence Impact Questionnaire both before and after treatment. Subjects also completed the validated Patient Satisfaction Questionnaire postoperatively to complete outcome analysis. Statistical analyses included a paired Student t test for intrapair comparisons and 2-sample t tests to compare mean differences between groups. Individual Incontinence Impact Questionnaire scores for the entire sample declined from a preoperative mean of 43.0 +/- 27.0% to a postoperative mean of 11.8 +/- 16.4 (P < .0001). On review of Patient Satisfaction Questionnaire responses, 45 patients (95.7%) were completely satisfied or somewhat satisfied, and 42 subjects (89.4%) stated their leakage was much better or better. The transobturator midurethral sling provides a significant improvement in quality-of-life and high postoperative patient satisfaction.

The midurethral polypropylene sling for stress incontinence: 22-month results of 81 patients

The objective was to review a cost-effective procedure called the midurethral polypropylene sling (MPS) in the treatment of urodynamic stress incontinence (USI). A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia by a special needle carrier. The sling is placed around the urethra and its sutures are tied on the fascia. The procedure was performed on 81 patients. Of these patients, 73 had USI. The remaining 8 patients with uterine prolapse, who did not have USI, underwent the MPS prophylactically. Of 81 patients, 35 underwent the MPS alone, 46 underwent the MPS and abdominal or vaginal procedures. Three patients had bleeding in excess of 300 ml necessitating a vaginal tamponade. One had hematoma and the other underwent a laparotomy. Urinary retention for more than 3 days was observed in 6 of the patients who had the MPS alone, in 7 of the patients who had both MPS and abdominal procedures, and in 13 of the patients who had MPS with vaginal procedures. The sling was cut in 3 patients due to persistent urinary retention. Of 73 patients with USI, 70 were completely cured (95.9%) at a mean of 22 months' follow-up. The cure rates and complications of the MPS were comparable to those of the tension-free vaginal tap (TVT) procedure for the treatment of USI. The procedure costs about US$ 9. We conclude that the MPS can be considered as an alternative to the TVT procedure.

350: Efficacy of SPARC Mid-Urethral Polypropylene Sling

350: Efficacy of SPARC Mid-Urethral Polypropylene Sling

A new, simple, safe, effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling.

We developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US dollar 9. We conclude that the MPS can be considered as an alternative to the TVT procedure.