Laparoscopy and Robotics in Stress Urinary Incontinence and Pelvic Reconstructive Surgery

Abstract Background : Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic relaxation. The purpose of this study is to evaluate the efficacies of Burch colposuspension, the transobturator tape (TOT), and single-incision needleless (DynaMesh®- SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. Methods: We carried out this prospective cohort study that comprising 142 patients who either underwent Burch colposuspension (n:43), TOT(n:40), or SIS(n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed the objective and subjective cure rates, improvement rates, along with failure and surgical success rates of SUI surgery. We assessed quality of life and symptom severity by Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), Sandvik Severity Index (SSI), Surgical Satisfaction Questionnaire (SSQ-8), Overactive Bladder Questionnaire V8 (OAB-V8), and Patient Global Impression of Improvement (PGI-I) scale scores. The primary outcome was surgical success, which was established when there was an improvement in patients or when the patients achieved objective or subjective cure, whereas secondary outcomes included intraoperative bladder injury, sling extrusion, de novo urgency, voiding dysfunction, length of hospital stay, and patient-reported outcomes in the quality of life questionnaires. Results: Surgical success rates were higher in Burch group than SIS group and also higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5% respectively, p=0.003) The complaints of urinary incontinence were higher and quality of life was lower in the SIS group than in the Burch group. In terms of IIQ-7, UDI-6, OAB-V8, SSI, and SSQ-8 scores, no difference was observed between Burch and TOT groups, and TOT and SIS groups. Conclusions: Both Burch and TOT are safe and effective procedures in patients with SUI who require additional pelvic surgeries. Although the surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further randomized studies are needed to clarify these observations due to unclear data.

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Long term outcomes of Burch colposuspension and transobturator tape and single incision needleless (DynaMesh ® - SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy

10.21203/rs.2.21791/v3 ◽

2020 ◽

Author(s):

Yesim Akdemir ◽

Fadime Dincer ◽

Cagatay Buyukuysal ◽

Ulku Ozmen ◽

Muge Harma ◽

...

Keyword(s):

Quality Of Life ◽

Urinary Incontinence ◽

Reconstructive Surgery ◽

Transobturator Tape ◽

Burch Colposuspension ◽

Pelvic Reconstructive Surgery ◽

Success Rates ◽

Surgical Success ◽

Subjective Cure

Abstract Background: Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse The purpose of this study is to evaluate the efficacies of Burch colposuspension, the transobturator tape (TOT), and single-incision needleless (DynaMesh®- SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. Methods: We performed this prospective cohort study that comprising 142 patients who either underwent Burch colposuspension (n:43), TOT(n:40), or SIS(n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed the objective and subjective cure rates, improvement rates, along with failure and surgical success rates of SUI surgery. We assessed quality of life and symptom severity by Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), Sandvik Severity Index (SSI), Surgical Satisfaction Questionnaire (SSQ-8), Overactive Bladder Questionnaire V8 (OAB-V8), and Patient Global Impression of Improvement (PGI-I) scale scores. The primary outcome was surgical success, which was established when there was an improvement in patients or when the patients achieved objective or subjective cure, whereas secondary outcomes included intraoperative bladder injury, sling extrusion, de novo urgency, voiding dysfunction, length of hospital stay, and patient-reported outcomes in the quality of life questionnaires. Results: Surgical success rates were higher in the Burch group than the SIS group and also higher in the TOT group than in the SIS group (88.4% vs 61.5% and 87.5% vs 61.5% respectively, p=0.003) The complaints of urinary incontinence were higher and quality of life was lower in the SIS group than in the Burch group. In terms of IIQ-7, UDI-6, OAB-V8, SSI, and SSQ-8 scores, no difference was observed between Burch and TOT groups, and TOT and SIS groups.Conclusions: Both Burch and TOT are safe and effective procedures in patients with SUI who require additional pelvic surgeries. Although the surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further randomized studies are needed to clarify these observations due to unclear data.

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