Transobturator Midurethral Sling Research Articles

A Danish national population-based cohort study of synthetic midurethral slings, 2007-2011.

Synthetic midurethral slings (MUSs) have shown similar cure rates in several short- and medium-term follow-up studies. Recently, long-term follow-up studies have indicated that the cure rate is higher following the retropubic midurethral sling (RPMUS) compared with the transobturator midurethral sling (TOMUS) procedure. The aim was to evaluate the efficacy of synthetic MUSs and to examine the influence of department and surgeon volume and patient-related factors on the cure rate of synthetic MUSs. A retrospective cohort study based on a national population over a 5-year period (2007-2011) using data from the Danish Urogynaecological Database (DugaBase). A total of 4519 women with first-time MUS were registered in the DugaBase. Cure was achieved in 1242/1639 (75.78%) at a 3-month follow-up. RPMUSs were more frequently in use in high-volume departments compared with the other departments and more often implanted by high- than low-volume surgeons. Women treated by a medium- (adjusted OR 1.82; 95% CI 1.01-3.28, "frequency") or high-volume surgeon (1.98; 1.18-3.32, "frequency") had an increased probability of cure compared with women treated by a low-volume surgeon. The difference was only significant for women who received a TOMUS. This national population-based cohort study confirmed a high cure rate of synthetic MUSs at short-term follow-up. It is the largest study to indicate a learning curve for TOMUS. Patients were not actively involved in which synthetic MUS was to be performed as the choice of surgical option was made at the departmental level.

Medial Thigh Anatomy in Female Cadavers: Clinical Applications to the Transobturator Midurethral Sling

Mesh resection for refractory pain after transobturator midurethral sling may require exploration of structures different than those involved in insertion. Our objective was to describe the muscular and neurovascular anatomy of the medial thigh compartment. Dissections were performed in unembalmed female cadavers. Relationships of medial thigh structures were evaluated relative to the midpubic arch and obturator nerve. An out-to-in transobturator tape was passed in a subset of cadavers, and its relationships to the obturator nerve and adductor muscles were examined. Descriptive statistics were used for analyses. Sixteen cadavers were examined. The adductor longus muscle was a median of 37 mm (26-50) from the midpubic arch with tendon length of 26 mm (12-53) and width of 16 mm (14-29). The gracilis was 21 mm (17-26) from the midpubic arch with tendon length of 28 mm (15-56) and width of 45 mm (31-68). The obturator nerve was 58 mm (51-63) from the midpubic arch with width of 5 mm (4-7). No differences between measurements in the supine and lithotomy positions were noted. The transobturator tape was 42 mm (30-47) from the midpubic arch, 36 mm (30-44) from the obturator nerve, and 20 mm (5-31) from the closest obturator nerve branch. The transobturator sling passed through the gracilis muscle in all specimens with variable passage through the adductors longus (75%) and brevis (25%). Familiarity with the medial thigh is essential for surgeons utilizing transobturator midurethral slings. Risks of mesh excision should be weighed against benefits before extensive thigh dissection for pain-related indications.

A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence.

Background:To assess the current evidence of effectiveness and safety of single-incision mini-slings (MiniArc) versus transobturator midurethral slings in the management of female stress urinary incontinence (SUI).Methods:A systematic search was performed from the electronic databases including PubMed, EMBASE, and Cochrane Library by November 2017. Using RevMan5.3 statistical software, the primary outcomes including subject and objective cure rates at 6 to 24 months follow-up were evaluated. Meanwhile, analysis was also performed for comparing the secondary outcomes such as peri- and postoperative complications, operative data, and quality of life.Results:Six randomized controlled trials (RCTs) and 6 retrospective cohort studies involving 1794 patients with SUI were analyzed based on the inclusion criteria. On the basis of our analysis, MiniArc was proven to have a noninferior clinical efficacy compared with transobturator midurethral slings with respect to the objective cure rate (risk ratio [RR] = 0.98, 95% confidence interval [CI] 0.94–1.03, P = .43) and subjective cure rate (RR = 0.97, 95% CI 0.91–1. 04, P = .38). In addition, pooled analysis showed that MiniArc had significantly lower postoperative pain scores (mean difference [MD] = −1.70, 95% CI −3.17 to −0.23, P = .02) and less postoperative groin pain (RR = 0.42, 95% CI 0.18–0.98, P = .04). Moreover, the MiniArc group also had a significantly shorter operation time (MD = −6.12, 95% CI −8.61 to −3.64, P < .001), less blood loss (MD = −16.67, 95% CI −26.29 to −7.05, P < .001), shorter in-patient stay (MD = 1.30, 95% CI −1.74 to −0.86, P < .001), and less urinary retention risk (RR = 1.15, 95% CI 0.46–2.87, P = .77). However, overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MiniArc compared with transobturator slings.Conclusions:This meta-analysis indicates that MiniArc is an effective method treating SUI. When compared with transobturator slings, it not only has a similar high cure rates, but also is associated with shorter operation time, less blood loss, more favorable recovery time, lower postoperative pain scores, less postoperative groin pain, less urinary retention, and absence of a visible wound. However, the findings of this study should be further confirmed by well-designed prospective RCTs with a larger patient series.

A randomized comparison of a single-incision needleless (Contasure-needleless®) mini-sling versus an inside-out transobturator (Contasure-KIM®) mid-urethral sling in women with stress urinary incontinence: 24-month follow-up results.

There is a shortage of reliable data on the efficiency of the under-investigated mini-slings to treat stress urinary incontinence (SUI). We aimed to compare the effectiveness of the single-incision needleless mini-sling (SIMS) with the transobturator inside-out mid-urethral sling (TOT). Two hundred one women with clinically proven SUI were included in this single-center prospective randomized trial. The patients were randomly allocated to the groups. All surgeries were done by the same single surgeon. Examinations were done by one other blinded surgeon. The patients were followed up for 24 months. Objective cure was defined as the absence of SUI and negative cough-stress test. Subjective cure was defined as no stress leakage of urine after surgery in a validated questionnaire. Failure of the surgery was defined as the need for reoperation. Every complaint was categorized by the IUGA/ICS Classification of Prosthesis-related Complications. The objective (85.4% versus 89.9%, p = 0.362) and subjective (87.6% versus 89.9%, p = 0.636) cure rates were similar with the TOT and SIMS at the postoperative month 24, respectively. The mesh exposure ≤ 1cm rate was 3.4% for both groups, and the mesh exposure > 1cm rate was 2.2% for both groups. Overall failure rates were 3.4% and 2.2% for the TOT and SIMS group, respectively. No viscus organ perforation was noted. Complications with the SIMS procedure were less painful compared with TOT (p = 0.024). Single-incision needleless mini-slings exhibited similar cure rates as the trans-obturator mid-urethral slings from both the patient and clinician points of view in 24months of follow-up. Mini-slings resulted in significantly less postoperative pain than trans-obturator mid-urethral slings.

Kadın Stres Üriner İnkontinans Tedavisinde Modifiye Otolog Transobturator Midüretral Askı Cerrahisi: İlk Sonuçlar

Amaç: Bu çalışmada, stres üriner inkontinans tedavisinde sentetik meşlerle ilişkili komplikasyonlardan kaçınabilmek için sentetik meş kullanmadan midüretral askı cerrahisi tanımlanmak istenmiştir. Bu amaçla modifiye otolog transobturator midüretral askı cerrahisi (m-OTOT) tekniğimizin kısa dönem sonuçları sunulmuştur. Gereç ve Yöntemler: m-OTOT uygulanan 20 hastanın preop ve postop ''The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)'' skorları, 1 saatlik ped testi ölçümleri, stres testi sonuçları, yaşam kalitesi ölçeği (QoL) ve postop ''Patients Global Impressions of Improvements (PGII)'' skalasını içeren datalar toplandı. Kategorik değişkenler, eşleştirilmiş bir Student t-testi kullanılarak karşılaştırıldı. Bulgular: Yaş ortalaması 50,5±3,3, beden kitle endeksi 28,9±3,9 kg/m2 olan 20 hastanın ortalama takip süresi 3,9±0,8 aydır. Ortalama ameliyat süresi 42,7±7,5 dakika ve komplikasyon oranı 1/20 (%5) (lokal tedavi ile iyileşen vajinal erozyon)'dir. PGI-I skoru 2 olarak belirtilmiştir ve ameliyat öncesine göre daha iyi olma durumunun karşılığıdır. Pozitif stres test oranı ve 1 saatlik ped testinde ağrılık artışı oranları postoperatif dönemde anlamlı olarak düşüktü. ICIQFLUTS formunda inkontinans bölüm skoru ve inkontinans bölümü yaşam kalitesi skoru postop dönemde anlamlı iyileşme göstermiştir, ayrıca toplam ICIQ-FLUTS skorU ve toplam yaşam kalitesi skoru da anlamlı olarak iyileşmiştir. Sonuç: Stres üriner inkontinans cerrahisinde mesh ile ilişkili komplikasyonlarından kaçınmak için, modifiye transobturator orta üretral sling tekniğimiz, kısa süreli etkinliği ve güvenlik profili ile hastalar ve cerrahlar için uygun bir seçenektir.

Mixed urinary incontinence: A prospective study on the effect of trans-obturator mid-urethral sling

ObjectivesIt is hypothesized that urethral dysfunction is central in mixed urinary incontinence (MUI) in women, since urine entering the proximal urethra under increased intra-abdominal pressure provokes a urethro-detrusorial reflex and involuntary detrusor contraction. Mid-urethral slings have been proposed as a solution. Our primary objective was to evaluate the long-term subjective and objective outcomes on continence and other urinary symptoms of a trans-obturator mid-urethral sling (TOT) procedure. Our secondary objectives were to determine its impact on quality of life (QoL), and to investigate which factors influence outcomes. Study designThis is a single-centre prospective study on a consecutive series of 86 women who underwent TOT for MUI as defined by ICS/IUGA. Since the definition of MUI that we used is symptom-based, we included patients both with and without associated detrusor overactivity. All patients underwent placement of Monarc® Subfascial Hammocks. Statistical analysisWe used the McNemar chi-square test, the paired t-test and Fisher’s exact test. A logistic regression model and odds ratios were used to assess age, parity, body mass index, menopausal status, preoperative detrusor over-activity, and detrusor pressure at maximum flow as possible factors for treatment failure. Only those that were statistically significant in the univariate analysis were included in the multivariate analysis. ResultsWith a mean follow-up of 59 months, SUI was cured objectively in 83.7% of patients and subjectively in 87.2%. Three patients underwent further anti-incontinence surgery. The continence rates were 74.4% for urgency urinary incontinence (UUI) and 66.3% for SUI-UUI. The patient-reported success rate was 87.2% (‘much better’ or ‘very much better’ on Patient Global Impression of Improvement scale). There were statistically significant improvements in all domains except general health. The univariate analysis found no significant risk factor for persistence of SUI. Median age >60 years and menopause were predictive for persistence of UUI. Median and mean age >60 years were predictive of persistence of overall incontinence. In the multivariate model, all variables lost their statistical significance. ConclusionOur study demonstrates TOT surgery can be performed for patients with MUI following unsuccessful conservative therapy. We also demonstrate that menopause and age >60 are risk factors for failure. This should be considered when counselling preoperatively.

Single-incision sling operations for urinary incontinence in women.

Single-incision sling operations for urinary incontinence in women.

Transobturator midurethral sling: What should patients expect after surgery?

Introduction and hypothesisMidurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement.MethodsThe study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS.ResultsSeven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes.ConclusionsA vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.

Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal.

To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center. Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively. The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies.

Reoperations for Female Stress Urinary Incontinence: A Finnish National Register Study

BackgroundSubjective and objective cure rates after primary surgery for female stress urinary incontinence are good. Still, some women will undergo repeated operations for incontinence. ObjectiveTo study the reoperation rate after incontinence surgery and to compare the reoperation rates between different surgery types. Design, setting, and participantsThis national register-based study included all Finnish women who had surgery for stress urinary incontinence during a 23-yr study period (1987–2009), both in inpatient and outpatient hospital settings. Subcohorts for follow-up times of 5-yr and 10-yr were evaluated separately. Outcome measurements and statistical analysisPrimary operations, reoperation rate, patient age, time until reoperation. Results and limitationsA total of 38 500 women had surgery for stress urinary incontinence from 1987 to 2009. Two thousand and seventy-six women (7.2%) had a reoperation with a rate of 7.8/1000 woman-yr. The reoperation rate was 8.3/1000 women-yr after a Burch colposuspension and 4.8/1000 after a retropubic midurethral sling. In the 10-yr follow-up, reoperation was more common after a Burch compared with a retropubic midurethral sling (odds ratio: 1.6, 95% confidence interval: 1.3–1.9). There was no difference in the reoperation rate between retropubic and transobturator midurethral slings in the 5-yr follow-up. ConclusionsReoperation rate is lower after midurethral slings compared with Burch colposuspension. Patient summaryMesh slings are surgically effective treatments for stress urinary incontinence. There are fewer reoperations after implanting these slings compared with older methods that do not use synthetic material. Different mesh slings have equally good results.

A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence.

Midurethral sling procedures are the first surgical option in women undergoing surgery for stress urinary incontinence (SUI). Single-incision midurethral-slings (SIMS) were designed to provide similar efficacy to traditional midurethral slings but with reduced morbidity. In this international trial we compared the efficacy of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS; Monarc) in the treatment of SUI in terms of subjective and objective cure rates and morbidity over a long-term follow-up. This was a randomized controlled nonblinded extended trial with a follow-up period of 36months. Women with symptomatic SUI were eligible. The primary outcome was subjective cure, defined as an improvement in the Patient Global Impression of Improvement (PGI-I) score. Secondary outcomes were objective cure (negative cough stress test), disease-specific quality of life, surgical parameters and morbidity. An intention to treat analysis was performed. Differences in dichotomous variables were tested using the chi-squared test. Differences in continuous variables were tested using Student's t test or the Mann-Whitney U test. We hypothesized that MiniArc would be noninferior to Monarc concerning subjective cure. We randomized 97 women to the MiniArc group and 96 to the Monarc group. The attrition rate was 23% in the MiniArc group and 22% in the Monarc group after 3years. At 36months, the subjective cure rates were 86% in the MiniArc group and 87% in the Monarc group (risk difference -0.6%, 95% CI -12 to 11%). The objective cure rates were 89% and 88%, respectively (risk difference 1.3%, 95% CI -9 to 11%). Both procedures were associated with low complication rates. After a follow-up of 36months, MiniArc (SIMS) is non-inferior to Monarc (SMUS) with respect to subjective and objective cure.

Association between body mass index and pain following transobturator sling

We aimed to prospectively evaluate the association between body mass index (BMI) and development of postoperative-onset pain in women undergoing transobturator midurethral sling procedures. We conducted a prospective, observational cohort study of women undergoing inside-to-out transobturator midurethral sling. At preoperative visit, height, weight, self-reported activity level and baseline pain were documented. At postoperative visits, patients indicated pain location and severity, procedure success, and satisfaction. We used log binomial regression to calculate risk ratios, controlling for potential confounders. For the 129 women included, median age was 50.0 years and BMI was 27.2 kg/m2. Adjusting for age and activity level, overweight and obese women had significantly increased risk of postoperative-onset pain compared to normal BMI women. Overweight women were at 1.70 (95%CI 1.05–2.75) times the risk compared to leaner counterparts, whereas obese women were at 1.76 times the risk (95%CI 1.04–2.89). Neither success nor satisfaction was associated with BMI.Impact statementOver three million midurethral slings have been placed worldwide for the treatment or prevention of stress urinary incontinence. The procedure has been studied in lean, overweight and obese populations, and found to have similar efficacy regardless of BMI. Similarly, the risks of midurethral sling have been well-documented, including the risk of pain after transobturator sling. Little attention has been given to whether this risk of postoperative pain varies based on patient BMI. Our previous work suggesting that leaner patients might be at increased risk of postoperative pain following transobturator sling was limited by the shortcomings of a retrospective study design.In this prospective study, we were able to adjust for age and activity level, finding that higher BMI women were at increased risk of postoperative pain, while reporting similar levels of satisfaction with the procedure. Future research is needed to find what differences in anatomy or physiology can explain this finding. From a clinical standpoint, thorough counselling of all patients but particularly those with elevated BMI, is required so that appropriate expectations regarding recovery can be set preoperatively.

V2-10 SURGICAL TECHNIQUE: TOTAL COLPOCLEISIS

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2017V2-10 SURGICAL TECHNIQUE: TOTAL COLPOCLEISIS Rena Malik, Carlos Finsterbusch, Catherine Harris, and Maude Carmel Rena MalikRena Malik More articles by this author , Carlos FinsterbuschCarlos Finsterbusch More articles by this author , Catherine HarrisCatherine Harris More articles by this author , and Maude CarmelMaude Carmel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.398AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Total colpocleisis is an excellent treatment option utilizing native tissue for complete vault eversion in older women not interested in coital function. This video illustrates our surgical technique for total colpocleisis. METHODS An 88 year-old female presented with pelvic organ prolapse (POP) after failing conservative management. She complained of concomitant storage and voiding lower urinary tract symptoms (LUTS), particularly stress urinary incontinence (SUI) with a pessary in place. Examination revealed complete procidentia and SUI with POP reduction. She elected to undergo total colpocleisis, and transobturator midurethral sling placement. RESULTS The procedure began by marking of four quadrants, from the apex to bladder neck, posterior and lateral vaginal walls. Lidocaine with epinephrine was used for hydrodissection and hemostasis. The vaginal epithelium was dissected and excised in each quadrant. Purse string sutures were placed sequentially at 2-3 cm from each other until the entire prolapse was reduced. Cystoscopy was performed to ensure patency of the ureters. The anti-incontinence procedure (not shown) was performed. The anterior vaginal wall was closed, followed by posterior vaginal wall closure including a tight perineorrhaphy. CONCLUSIONS On examination at 6 months, no recurrence of her prolapse was noted. Further, the patient reported that her SUI and LUTS had resolved. Colpocleisis remains an effective and minimally invasive option for women with severe POP who are not interested in maintaining sexual function. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e136 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Rena Malik More articles by this author Carlos Finsterbusch More articles by this author Catherine Harris More articles by this author Maude Carmel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Large Retrospective Series of Pregnancy and Delivery After Midurethral Sling for Stress Urinary Incontinence.

The aim of this study was to review the complete medical course, including safety, efficacy, and medical decision making, of patients who delivered a pregnancy after the placement of midurethral sling (MUS) within a large health maintenance organization. We conducted a retrospective case series of patients within the Northern and Southern California Permanente Medical Group who were identified based on procedural codes for placement of MUS for stress urinary incontinence. Electronic medical records with MUS code were referenced against records of live births within the health care system. Demographic and clinical data were abstracted through extensive, standardized physician review of the electronic medical records of all identified patients. Twenty-six patients were identified and included in analysis. Sixteen patients had a retropubic MUS, and 10 had a transobturator MUS. Twenty-one of 26 patients reported subjective resolution of urinary incontinence after MUS. Fourteen of the 25 first deliveries after MUS were cesarean section (CS). Of these, 5 CS were elective primary for the indication of previous MUS, 5 were elective repeat CS, and the remaining 4 were for fetal indications. Eleven patients had spontaneous vaginal deliveries. There were no MUS-related pregnancy complications. One patient developed recurrent stress urinary incontinence postpartum, for which she underwent repeat MUS within a year resulting in cure of incontinence. This case series corroborates previous series demonstrating the safety and durability of MUS after subsequent pregnancy.

Midurethral sling: is there an optimal choice?

Midurethral slings (MUS) are the most common procedure performed for female stress urinary incontinence (SUI). Several variations have been introduced and evidence supporting the optimal approach for outcomes is necessary. The bottom-up approach to the retropubic MUS may have higher subjective cure rates and lower rates of bladder puncture, voiding dysfunction, and vaginal extrusion compared to the top-bottom approach. Short-term and medium-term cure after retropubic and transobturator approaches are similar, whereas the retropubic approach may have better outcomes in the long term. The transobturator approach, however, appears to be associated with less bladder puncture, vascular injury, and postoperative voiding dysfunction, albeit at the expense of greater groin pain. De-novo storage symptoms and impact on sexual function are similar. The single incision mini sling (SIMS) may offer similar cure rates as the transobturator approach, with lower rates of early postoperative pain. SIMS offers inferior cure rates compared with the retropubic MUS. The bottom-up retropubic MUS may currently be the 'optimal' MUS procedure; however, the transobturator MUS should also be considered. Long-term results are currently emerging and detailed informed consent is required regardless of the approach.

Long-term patient satisfaction after retropubic and transobturator mid-urethral slings for female stress urinary incontinence.

The aim of this study was to report long-term patient outcomes after retropubic and transobturator mid-urethral slings for female stress urinary incontinence. Women who underwent mid-urethral sling for stress urinary incontinence between 2000 and 2010 were invited to participate in a survey regarding their overall improvement. Patients' outcomes were assessed using the International Consultation on Incontinence Questionnaire - Short Form and the Global Response Assessment Scale. The questionnaires were completed by 330 patients. Their median age at the time of surgery was 54.8 years (±12.9) and the median follow-up period was 11.9 years (±6.4). Retropubic and transobturator approaches were performed in 128 (38.8%) and 202 (61.2%) patients, respectively. The International Consultation on Incontinence Questionnaire - Short Form score dropped from an average of 14 (±4.1) to 6.4 (±6) with no significant difference between the two groups. The Global Response Assessment Scale showed an 9% greater improvement in the retropubic (66.4%) over the transobturator (57.4%) approach. De novo overactive bladder was the commonest long-term reported adverse event, affecting 18/330 patients (5.5%). Voiding dysfunction that required surgical correction following the retropubic approach occurred in three patients (2.3%). Mid-urethral slings for the management of female stress urinary incontinence had good and durable long-term effects. Although the retropubic approach gave better results, they were not significantly different than those of the transobturator approach.

Prospective Evaluation of the Effect of Thigh Dissection for Removal of Transobturator Mid Urethral Slings on Refractory Thigh Pain

Transobturator slings have higher rates of de novo neurologic symptoms than retropubic slings, most commonly related to the thigh. Cases refractory to conservative management may require removal of the thigh portion of the sling. In this series we prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from October 2012 to October 2015. Patients were assessed preoperatively, with a pain score using a visual analog scale, and postoperatively with a global response assessment. A total of 12 thigh dissections were performed from October 2012 to October 2015 in 8 patients. Mean (±SD) time from original mesh placement to presentation was 2.7 (±1.5) years. Average preoperative pain score was 7.9(±1.7) out of 10, with pain in the thigh in all patients. Seven cases involved unilateral thigh dissection and 1 had concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. On postoperative evaluation the average global response rating was 1.6, with 1 defined as very much better and 2 defined as much better. Of the 8 patients 3 went on to have the contralateral side done with an average global response rating of 1.3 (±0.6). One patient underwent further treatment for stress urinary incontinence with placement of a retropubic mid urethral sling. Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. The procedure can be performed safely with positive outcomes for the patient.

MP65-13 PROSPECTIVE EVALUATION OF THE EFFECT OF THIGH DISSECTION FOR REMOVAL OF TRANSOBTURATOR MIDURETHRAL SLINGS ON REFRACTORY THIGH PAIN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II1 Apr 2016MP65-13 PROSPECTIVE EVALUATION OF THE EFFECT OF THIGH DISSECTION FOR REMOVAL OF TRANSOBTURATOR MIDURETHRAL SLINGS ON REFRACTORY THIGH PAIN Ashley King, Christopher Tenggardjaja, and Howard Goldman Ashley KingAshley King More articles by this author , Christopher TenggardjajaChristopher Tenggardjaja More articles by this author , and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1224AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) can be treated successfully with both retropubic and transobturator midurethral synthetic slings. Transobturator slings were developed to decrease the risk of injury to the viscera and have been found to have lower rates of de novo irritative symptoms. However, they do have higher rates of de novo neurologic symptoms, most commonly related to the thigh. These symptoms can initially be treated conservatively; however, refractory cases may require removal of the thigh portion of the sling. The objective of our series was to prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. METHODS All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from 10/2012 to 10/2015. Patients were assessed thoroughly preoperatively, including obtaining a pain score using a visual analog scale, and postoperatively with a global response assessment. RESULTS A total of 11 thigh dissections were performed from 10/2012-10/2015 on 8 patients. All patients had failed conservative management. All cases were performed by a single urologist without any consulting surgeons. Average age of the patients was 53.7 (± 9.2), and the mean time from mesh placement to presentation to our clinic was 2.7 (± 1.5) years. Prior to our initial thigh dissection, 62.5% of the patients had already undergone transvaginal mesh excision. Average preoperative pain score was 7.9 (± 1.7) out of 10 with pain in the thigh in all patients. Initially, 7 cases involved unilateral thigh dissection; one patient underwent concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. Average operative time was 135.8 (± 145.5) minutes; mean estimated blood loss was 77.9 (± 35) mL. On postoperative evaluation, the average global response rating was 1.6 with 1=very much better and 2=much better. Four of the eight patients went on to have the contralateral side done with average global response rating of 1.3 (±0.6). One patient underwent further treatment for SUI with placement of a TVT sling. CONCLUSIONS Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. Significant relief of symptoms is possible in the small minority of patients with significant thigh pain after transobturator slings. The procedure can be performed safely with positive outcomes for the patient. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e869 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ashley King More articles by this author Christopher Tenggardjaja More articles by this author Howard Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

14: Robotic-assisted laparoscopic removal of eroded transobturator midurethral sling after failed cystoscopic excision

14: Robotic-assisted laparoscopic removal of eroded transobturator midurethral sling after failed cystoscopic excision

Outcomes of three sling procedures at the time of abdominal sacral colpopexy.

A sling at time of sacral colpopexy (SCP) for apical pelvic organ prolapse (POP) is valuable in the treatment of overt, urodynamic, and occult stress urinary incontinence (SUI). As there is no current agreement regarding the optimal choice of sling in these women, we compare the outcomes of three sling procedures in this population: autologous rectus fascia bladder neck sling (ARF), retropubic midurethral sling (RPM), and transobturator midurethral sling (TOM). We performed a retrospective single institution, single-surgeon review of data identifying women with minimum follow-up of 12 months who underwent a concomitant sling and SCP following urodynamics with and without POP reduction. Preoperative and postoperative evaluation included objective and subjective assessment. Cure required absence of subjective and objective SUI. Out of 187 women, 152 (81%) met inclusion criteria (49 ARF, 58 RPM, and 45 TOM). There were no significant differences among sling groups regarding demographics. SUI cure rates were not significantly different between sling groups, or within each group after stratification by overt and occult SUI. QoL indices improved significantly after surgery for the entire cohort. All three sling types appear to produce similar cure rates of SUI when done concomitantly with SCP. There did not appear to be any significant differences when stratified by occult or overt SUI. No sling type was associated with more postoperative complications. Larger studies are necessary to confirm the findings of this single-institution, retrospective study. Neurourol. Urodynam. 36:482-485, 2017. © 2016 Wiley Periodicals, Inc.