Suburethral Sling Research Articles

Sub-urethral Mini Sling versus Transobturator Vaginal Tape for Treatment of Female Stress Urinary Incontinence, One Year Follow-up

Background: Stress urinary incontinence (SUI) is a common problem in women, which accounts about 50% of all incontinent women and affects the quality of life. The mid-urethral sling is the mainstay of SUI treatment over the last years. Tension-free vaginal tape (TVT), has been used as minimally invasive procedure for SUI. Objective: To compare outcomes of sub-urethral minisling and transobturator tape (TOT) for treatment of female SUI, one year follow up regarding operative time, length of hospital stays, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence. Patients and Methods: This comparative study has been conducted in Al-Hussein and Sayed Galal Hospitals; Al-Azhar University; Cairo; Egypt and it included 96 cases, 8 patients missed communication data, 9 refused to participate, 34 in minisling group and 45 in transobturator tape (TOT) group. This a retrospective study for follow up of operated cases during the period from July 2015 to June 2018 at the Urology Department, Al-Hussein, Sayed Galal University Hospitals; Cairo; Egypt. Results: In our study, the minisling operation was associated with nearly the same hospital stay of transobturator tape (TOT). We had early recurrence rate among minisling operation. Finally, the transobturator tape (TOT) operation was associated with less recurrence rate and recurrence time postoperatively compared to the minisling. Conclusion: Minisling when compared to transobturator tape (TOT) for treating SUI; transobturator tape (TOT) yielded better outcomes regarding the postoperative 1 year follow up compared to the minisling.

The association between personal history and the outcomes of transobturator sling surgery.

This study aims to verify the association between risk factors for the onset of SUI and transobturator suburethral sling surgical treatment outcomes. A retrospective study was conducted with 57 patients operated by the Pelvic Floor Surgery Service. Demographic data were compiled from the sample, the body mass index (BMI) was calculated, and the patients were divided according to the response to the surgical treatment. A total of 77.2% of the sample was cured or improved after surgical treatment. Out of the total sample, 75.4% of the women were postmenopausal, and 73.7% denied current or past smoking. The median age was 61 years, the median number of births was 4.0, the median BMI was 28.6 kg/m2, and 50.9% of the sample was classified as pre-obese. BMI, menopausal status, age, smoking, and sexual activity were not factors associated with the surgical outcome. However, parity equal to or greater than 5 was associated with worse postoperative results (p = 0.004). among risk factors associated with the emergence of SUI, only parity greater than 4 showed a negative impact on transobturator sling surgery outcomes.

Durability of Retropubic Suburethral Sling Procedure and Predictors for Successful Treatment Outcome in Women With Stress Urinary Incontinence

ObjectiveTo investigate the long-term durability of retropubic suburethral sling procedure for female stress urinary incontinence (SUI) and to identify urodynamic factors that might predict long-term successful outcomes. Materials and MethodsIn total, 286 women who underwent a retropubic suburethral sling for SUI were enrolled in this retrospective survey. Most patients received uroflowmetry, postvoid residual volume study and standardized video urodynamic testing preoperatively and 6 months postoperatively in half of them. Surgical results, demographic characteristics, preoperative and postoperative urodynamic parameters, and postoperative clinical manifestation were retrospectively analyzed. Urodynamic parameters that predict a failure outcome were investigated. ResultsThe median follow-up period was 10 years (4-29 years). The overall subjective cure rate was 80.8%. The success rates of the sling procedures at 3, 5, 10, 15, and 20 years were 89.2%, 87.7%, 78.8%, 68.6%, and 60.0%, respectively. Vaginal delivery and greater parity had negative influence on cure rate (P = .004 and .013, respectively). A significant interaction was detected from the baseline to 6 months between successes and failures for maximum flow rate (Qmax) (P = .007), voided volume (P = .020), and bladder outlet obstruction index (P = .001). Univariate analysis revealed significant decrease of Qmax, volume, and voiding efficiency; and increase of postvoid residual volume, detrusor pressure, and bladder outlet obstruction index in patients with successful outcome. However, multivariate logistic regression failed to find predictive factors for a failure suburethral sling procedure. ConclusionRetropubic suburethral sling has a durable long-term effect for SUI. Slightly increased bladder outlet resistance after retropubic suburethral sling might be helpful for achieving long-term dryness.

Effect of Visual Aids During Surgical Consents on Patient Understanding and Satisfaction.

This study aimed to assess whether the use of visual aids to augment the consent process for pelvic floor surgeries affects patient understanding and satisfaction. We conducted a single-blind, randomized controlled trial. Adults planning robotic sacrocolpopexy or suburethral sling surgeries were eligible. All participants received standard preoperative consent counseling. Participants randomized to the intervention also viewed slides with visual aids that paralleled standard counseling; participants randomized to the control group received only standard counseling. All participants completed surveys after their preoperative visit, the day of surgery, and at their postoperative visit. Each survey contained 12 true-false questions about risks, benefits, and alternatives of surgery, and expectations during recovery. The primary outcome was the percentage of correct true-false questions. We conducted an intention-to-treat analysis. We randomized 32 participants undergoing robotic sacrocolpopexy and 32 undergoing suburethral sling surgeries, yielding 16 in the intervention group and 16 in the control group for each procedure. The intervention and control groups for both surgeries were similar in age, body mass index, race, education, and previous surgery for similar symptoms.Among participants undergoing robotic sacrocolpopexies, median knowledge scores at the preoperative visit were similar between the intervention (92% [interquartile range {IQR}, 86%-100%]) and control (86% [IQR, 75%-94%]) groups (P = 0.21). Similar results were seen for participants undergoing suburethral sling procedures in the intervention (83.3% [IQR, 71%-92%]) and control (83% [IQR, 75%-88%]) groups (P = 0.64). We found that using visual aids during the consent process for patients undergoing robotic sacrocolpopexy or suburethral sling surgeries did not improve knowledge.

Ins and outs in the surgical treatment of female stress urinary incontinence

Proper indication, preoperative diagnostics and final choice of surgical technique in the operative management of female stress urinary incontinence are subject to somewhat irrational, trend-based changes. For various reasons (insufficient reimbursement, poor expertise, limited therapeutic spectrum) preoperative urodynamic tests are increasingly thought to be unnecessary and are progressively replaced by perineal ultrasound despite lack of evidence. Since the AWMF guidelines (AWMF: Association of the Scientific Medical Societies in Germany) for the diagnosis and treatment of stress urinary incontinence in women were published, individualized planning of therapy is "out". Unconditional guideline adherence in certified pelvic floor centers, which have become very popular in Germany, has furthermore restricted the spread of therapeutic options due to minimum procedure number requirements. With regard to suburethral tension-free alloplastic slings, the retropubic version, which was temporarily unfashionable, has been experiencing arenaissance at the cost of the transobturator alternative. Single-incision slings were developed for the outpatient US market and have never become established in Germany due to lack of proof of superiority. In the setting of alimited spectrum of surgical procedures, adjustable sling systems offer promising treatment options for risk groups with acceptance of higher infection and erosion rates, thus gaining popularity. Reliable and comprehensive preoperative patient information comprising the whole spectrum of therapeutic options with individual risks and opportunities is key to prevent the impending ban of alloplastic implants in female stress incontinence surgery.

Magnetic resonance imaging as an assessment tool following intervention with an AdVance XP suburethral sling for postprostatectomy urinary incontinence.

The aim of this study was to compare magnetic resonance imaging (MRI) parameters in patients with mild incontinence after radical prostatectomy, who had undergone treatment with a suburethral sling. The objective was to compare patients who had been successfully treated with unsuccessful patients. This observational cohort study at a single institution evaluated consecutive patients treated with an AdVance XP sling. MRI was performed using a 1.5 Tesla system. Preoperative urodynamic assessment and flexible cystoscopy were performed. The qualitative analysis was based on sling indentation (complete vs incomplete). The quantitative analysis comprised the following three parameters: the sling-pubis distance, the thickness of the proximal urethral bulb, and the sling backward distance (SBD), defined as the distance between the prolongation of a line through the major axis of the pubis (the line-segment joining the vertices of the pubis) and the sling indentation. The primary outcome was pad count at 3 months; cure as zero pads. A logistic univariate regression model was employed to assess the potential predictors of successful outcomes. An adjusted multivariate logistic regression model using the significant univariate factors was developed. Of the 83 patients enrolled, the univariate analysis revealed a relationship between failure and adverse urodynamics and between success and sling indentation, thickness of the proximal bulb and SBD. Only the association with SBD persisted in the multivariate analysis. MRI revealed a strong relationship between proper positioning of the sling (small SBD) and continence outcome. These data have important implications for a second surgery following initial sling failure.

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

IntroductionThe midurethral sling has become the current standard for the treatment of female stress urinary incontinence.AimTo assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures.Material and methodsThe analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6- and 12-month follow-up.ResultsA significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13–0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16–0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97–6.3; OR = 2.3, 95% CI: 0.95–5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality.ConclusionsTVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.

PD02-09 OUTCOMES OF MACROPLASTIQUE INJECTIONS FOR STRESS URINARY INCONTINENCE AFTER SUB-URETHRAL SLING REMOVAL

INTRODUCTION AND OBJECTIVES:Following suburethral sling removal (SSR) for synthetic sling complications, stress urinary incontinence (SUI) may occur in up to 59% of patients(1). Our study sought to...

Utility of Preoperative Laboratory Testing in Women Undergoing Suburethral Sling.

The aim of the study was to examine current patterns and factors associated with preoperative testing in patients undergoing midurethral sling and to compare 30-day outcomes in subjects. This retrospective cohort study was performed using the National Surgery Quality Improvement Program database from 2005 to 2014. All women undergoing midurethral slings were identified by Current Procedural Terminology code. Clinical variables were abstracted and the incidence of preoperative serum labs was determined. Multivariable logistic regression was used to estimate associations between clinical factors and collection of preoperative serum labs and between 30-day outcomes and collection of labs. A total of 12,368 women underwent midurethral sling in the National Surgery Quality Improvement Program database during the study period. Preoperative serum testing within 30 days before surgery was observed in 9172 (74.2%) women. Age, American Society of Anesthesiologists class, diabetes, and hypertension were strongly associated with preoperative testing when modeling together in multivariable regression. Of the 543 women who had any complication, 410 (75.5%) received preoperative testing. Urinary tract infection was the most frequent complication (66.1%). Age, American Society of Anesthesiologists class, body mass index, and presence of any comorbidity were associated with the presence of any complication at 30 days. Adjusting for these factors, the odds of complications were not significantly different between those who did and did not have preoperative testing (adjusted odds ratio = 0.98, 95% confidence interval = 0.78-1.24). Most women who underwent midurethral sling procedures had preoperative testing. Major postoperative complications were uncommon, and there was no substantial difference in outcomes between women who underwent preoperative testing and those who did not. In the future, surgeons may consider eliminating preoperative testing in low-risk patients.

790 - The transobturator sub-urethral sling: A safe and effective option for all degrees of post prostatectomy urinary incontinence

790 - The transobturator sub-urethral sling: A safe and effective option for all degrees of post prostatectomy urinary incontinence

Bladder dysfunction does not affect long-term success rate of the retropubic suburethral sling procedure in women with stress urinary incontinence.

This study investigated the long-term success rate of retropubic suburethral sling in the treatment of women with stress urinary incontinence (SUI) and different bladder function. Surgical outcomes of women with SUI undergoing a retropubic suburethral sling procedure between October 1989 and November 2014 were analyzed retrospectively. Bladder function was evaluated in every patient preoperatively using videourodynamic studies. Patients were classified as having stable bladder, detrusor overactivity (DO), or detrusor underactivity (DU). Baseline urodynamic parameters were analyzed and long-term therapeutic outcomes were compared among these three groups. In all, 403 patients underwent sling procedure for SUI. Of these, 291 (72.2%) had a stable bladder, 78 (19.4%) had DO, and 34 (8.4%) had DU. Mean (± SD) patient age was 60.2 ± 11.8 years, and the median follow-up was 97 months (interquartile range 24-325 months). Postoperatively, the overall continence rate was 83.4% (336/403). After surgery, 71 patients (17.6%) complained of dysuria, 14 (3.5%) complained of urgency incontinence, 25 (6.2%) had recurrent SUI requiring a secondary sling procedure, and urethrolysis was performed in 13 (3.2%). In the stable bladder, DO, and DU groups, the 5-year continence rates were 88.6%, 84.1%, and 79.4%, respectively (P = 0.59), whereas the 10-year continence rates were 83.8%, 72.9%, and 79.4%, respectively. Kaplan-Meier survival analysis indicated that the long-term success rate was similar among the three groups (P = 0.39). The overall continence rate was 83.4% and the 10-year continence rate was satisfactory in all bladder function subgroups. Treatment outcomes were the same for women with SUI but different bladder function.

Comparison of the effects of two methods in the treatment of urinary incontinence after transurethral resection of prostate

Objective To compare the effects of ball of urethra suspension with Yiqi perturbation urine and subtract two methods in the treatment of urinary incontinence after transurethral resection of prostate. Methods From February 2012 to February 2017, 60 patients with urinary incontinence after transurethral resection of prostate in the Third People's Hospital of Shuozhou were selected.According to different therapeutic methods, the patients were divided into two groups, with 30 cases in each group.The control group was treated with ball of urethra suspension, the observation group was given Yiqi perturbation for urine.The incidence of urinary incontinence and degree of the two groups after treatment were observed.The incontinence duration, international prostate symptom score, residual urine volume, maximum urine flow rate and patients' quality of life scores were compared between the two groups. Results After treatment, the incidence rate of urinary incontinence in the observation group was 8.3%, which was significantly lower than 23.3% in the control group (χ2=10.28, P<0.05). The incontinence duration, international prostate symptom score, residual urine volume, maximum urinary flow rate in the observation group were (7.6±2.1)d, (21.2±3.4)points, (119.5±60.4)mL, (4.1±1.3)mL/s, respectively, which were better than those in the control group [(15.8±3.2)d, (5.6±1.5)points, (19.7±6.9)mL and (20.4±5.3)mL/s], the differences between the two groups were statistically significant (t=11.73, 22.99, 8.99, 22.99, all P<0.05). The quality of life scores in the observation group were better than those in the control group (all P<0.05). Conclusion Yiqi perturbation urine for urinary incontinence caused by transurethral resection of benign prostatic hyperplasia is better than the ball of urethra suspension, it can reduce the degree of postoperative incontinence, improve patients' quality of life. Key words: Urinary incontinence; Postoperative complications; Transurethral resection of prostate; Suburethral slings; Yiqi perturbation urine; Medicine, Chinese traditional; Controlled clinical trial

PO637 Cardiac Chamber Enlargement Is Associated With More Significant Mitral Regurgitation In Children Screened For Rheumatic Heart Disease

The impact of surgery for stress urinary incontinence (SUI) on female sexual function has received attention in the medical literature, but not in a structured manner.To assess the most recent evidence on the impact of surgical management for female SUI on female sexual function.The review and meta-analysis of available articles published in Medline, Cochrane, LILACS, SCOPUS, Web of Science, CINHAL, and EMBASE included prospective randomized and non-randomized studies that assessed patients who underwent surgical treatment for UI through 2 validated questionnaires: the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Female Sexual Function Index (FSFI).The following terms were searched: (urinary incontinence OR female OR woman OR women) AND (suburethral slings OR transobturator tape* OR transobturator suburethral tape OR trans-obturator tape* OR urethral sling* OR midurethral sling* OR mid-urethral sling* OR “standard midurethral slings” OR tensionless vaginal tape* OR mini sling* OR Burch* OR “Burch colposuspension” OR “urologic surgical procedures” OR “tension-free vaginal tape” OR pubovaginal sling) AND (sexual behavior OR “Female Sexual Function Index” OR FSFI OR sexual function OR “Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire” OR PISQ-12).1,043 articles were retrieved; 9 studies were included for qualitative analysis and 4 were included for meta-analysis. 25 articles were excluded because they used questionnaires other than the FSFI and PISQ-12. Meta-analysis of 2 studies composed of 411 women who underwent to retropubic and transobturator sling intervention and completed the PISQ-12 questionnaire showed an increase in sexual function of 2.40 points after transobturator compared with retropubic sling intervention (95% CI = −2.48 to −2.32; I2 = 35%, P < .00001). However, 2 other studies composed of 183 women comparing the same techniques, but using the FSFI, did not show a statistically significant difference (95% CI = −1.77 to 3.78; I2 = 0%, P = .48).The impact of UI surgery on sexual function is uncertain because of the imprecision of the effect and inconsistency among studies. Only limited evidence on the impact of the transobturator vs the retropubic sling was found.Bicudo-Fürst MC, Borba Leite PH, Araújo Glina FP, et al. Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis. Sex Med Rev 2018;6:224–233.

Efficacité des ballons Pro-ACT™ dans le traitement de seconde ligne de l’incontinence urinaire d’effort post-prostatectomie après échec des bandelettes sous-urétrales

The periurethral adjustable balloons (PUAB) Pro-ACT™ are less invasive technique to treat non-severe forms of post-radical prostatectomy urinary incontinence (pRP-UI), like sub-urethral trans-obturator male sling. Few data of efficiency are available for their use in second line treatment after male sling failure. To evaluate the efficiency of PUAB Pro-ACT™ (Uromedica, Inc., MN, USA) in the second line treatment for non-severe pRP-UI after male sling failure. Single center retrospective study of patients treated with male sling (17Advance™, 1TOMS™) between 2009and 2015. The continence results were evaluated by the number of pad per day and the quality of life assessment by the I-QOL questionnaire. The "cure" was defined as no pad and "improved" as decreased more than 50% of pads use. Eighteen patients were included with median follow-up of 21.5 [14-44] months. Two patients (11.1%) had a past history of pelvic radiotherapy. The median pads per day used was 2 [1-3] after male sling insertion and before Pro-ACT™ device insertion. After Pro-ACT™ device insertion, the median pads per day used was 0 [0-1], with 77.7% of patients cured and 22.2% improved. The median quality of life score I-QOL, was 52.2 [23.3-62.6] and 83 [31.8-97.7], respectively before and after Pro-ACT™ device insertion (P<0.001). Nine (60%) patients rated their incontinence severity as mild, four (26.6%) as middle and two (13.3%) as severe, after balloon insertion. The median volume of adjustment was 3 [2-6] mL. The PUAB Pro-ACT™ have a significant efficiency for use after male sling failure and can be used in second line therapy. 3.

Mini-bandelette sous-urétrale versus bandelette transobturatrice : efficacité et morbidité

ObjectiveTo compare the effectiveness of an ALTIS® mini-sling and a conventionnal suburethral sling TVT-ABBREVO® for treatment of female stress urinary incontinence. MethodsA single-center retrospective study included all female patients fitted with a conventional transobturator tape (TVT-ABBREVO®) or mini-sling (ALTIS®), during 2015, in Angers university hospital. The success rate was defined by no urine leakage during a cough test on clinical examination, improved quality of life defined by a PGI-I (Patient Global Impression of Improvement) score of 1 to 3, and no stress urinary incontinence on USP (Urinary Symptom Profile) questionnaire. Morbidity associated with slings and perioperative data were also recorded. ResultsNinety-two patients were included (39 in the ALTIS group and 53 in the ABBREVO group). The average follow-up was 13.55 months. The success rate was not significantly different in ALTIS group for the negative cough test (89.7% vs 94.3% in ABBREVO group, P=0.45), for the absence of urinary leakage reported on the USP questionnaire (87.2% vs 90.6% in ABBREVO group, P=0.61), or for the improvement of the quality of life with a PGI-I score between 1 and 3 (82.1% vs 86.8% in ABBREVO group, P=0.53). On the other hand, more patients were fully satisfied, with a PGI-I quality of life score of 1, in ABBREVO group than in ALTIS group (67.9% compared with 46.2%, P=0.03). Immediate postoperative pain was significantly less intense in ALTIS group than in ABBREVO group (average VAS score of 0.5 comparated with 1.3, P=0.01), but this difference had disappeared one week after surgery. The rates of other complications were similar in both groups. ConclusionThe functional results of the ALTIS and TVT-ABBREVO® slings appear similar in the treatment of female stress urinary incontinence.

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre.

Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

TVT Abbrevo and Miniarc suburethral sling in women with stress urinary incontinence – A randomised controlled trial

IntroductionSingle incision slings (SIS) were introduced in an attempt to decrease the complications associated with retropubic and transobturator slings. The TVT Abbrevo is a modification of the TVT-O with a reduced length and less immediate postoperative pain. The Miniarc SIS has been shown to be equivalent to outside-in transobturator sling, Monarc at 12 month follow-up. ObjectiveTo evaluate objective and subjective outcomes of MiniArc SIS and TVT Abbrevo midurethral sling (MUS) in women with stress urinary incontinence. MethodsFemale subjects who were assessed and referred for stress urinary incontinence surgery were eligible to participate in this study. Exclusion criteria included women with intrinsic sphincter deficiency previous failed midurethral or fascial sling, untreated detrusor overactivity or significant voiding dysfunction.Patients’ randomisation was performed with computer-generated blocks of 4–8, with concealed allocation. Assuming an objective cure rate of 90% for TVT AbbrevoTMwith a power of 80%, a sample size of 79 in each arm was required to detect a clinical difference of 15%, using a one sided alpha of 0.05.The target recruitment number was 220 allowing for an attrition rate of 15%.Institution ethics approval (11261B) was obtained and the trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611001151921).Routine preoperative assessment was conducted for objective data, whilst patient reported outcome tools (PRO) were utilised for subjective outcomes. These include ICIQ UI SF, ICIQ OAB, IIQ7, EQ5D, PISQ12, PGIs & PGII.TVT AbbrevoTM or MiniarcTMwere performed in a standardized fashion, together with any concomitant prolapse surgery. Review was conducted at 6 weeks and at 6 and 12 months.Objective cure was defined as a negative cough stress test with a comfortably full bladder. Subjective cure was defined as no report of leakage with physical exertion. All Data was collected and outcomes were analysed statistically. ResultsBetween February 2011 and January 2016,a total of 246 women were randomized to receive MiniArc (121) or TVT Abbrevo (125). Baseline characteristics were clinically balanced in both groups.At 6 months subjective (94.4% vs 95.7% p=0.74) and Objective (92.9% vs 95.9% p=0.49) cure rates were high and not statistically different.At 12 months there were also no differences in subjective (73.6% vs 76.9% p=0.73) or objective (90.5% vs 96.0% p=0.21) cure rates.No differences were found in functional outcomes or when adjusted for potential confounding factors such as age, parity, BMI or menopausal status. ConclusionWe found no significant differences in subjective and objective cure rates at 6 and 12months between MiniArc and TVT Abbrevo.

Reply by Authors

No AccessJournal of UrologyLetter to the Editor/Errata1 Dec 2018Reply by Authors View All Author Informationhttps://doi.org/10.1016/j.juro.2018.06.101AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, 200(6), pp. 1380–1381 References 5 : The ‘iris effect’: how two-dimensional and three-dimensional ultrasound can help us understand anti-incontinence procedures. Ultrasound Obstet Gynecol2004; 23: 267. Google Scholar 6 : The urethral motion profile before and after suburethral sling placement. J Urol2010; 183: 1450. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 6December 2018Page: 1380-1381 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Long-term outcomes of anti-incontinence surgery and subsequent transvaginal sling incision for urethral obstruction.

The suburethral sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A transvaginal sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal sling (PVS) procedure and subsequent transvaginal sling incision for urethral obstruction. We retrospectively reviewed the voiding conditions of women who underwent transvaginal sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients' Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation. Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent transvaginal sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after sling incision was 91.1 ± 50.7months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively. Transvaginal sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via sling incision. Most patients could maintain urinary continence and reported good satisfaction.

061 The male sub-urethral sling versus the artificial urinary sphincter for treatment of stress urinary incontinence

An increasing number of men are seeking surgical treatment for stress urinary incontinence (SUI). With the emergence of the less invasive sub-urethral slings, the dominance of the Artificial Urinary Sphincter (AUS) has been challenged. We have looked at our series of surgically treated, male SUI in a regional implant centre to compare outcomes from both modalities and identify risk factors for failure. This was a prospective study, incorporating all prostheses patients over 3 years. The groupe were matched for age and aetiology of incontinence. ... The major risk factor for complications, in both groups, was the combination of radical prostatectomy and radiotherapy. In the AUS group, 8 patients had undergone both. 4/8 had complications and 2/8 suffered erosions requiring staged reconstruction. In the sling group, 3 patients had undergone dual treatment and 2/3 of them failed to improve sufficiently. These patients have both been subsequently offered AUS insertion.