scholarly journals Short-, medium- and long-term results of the sling operations effectiveness and safety for urinary incontinence in women

2020 ◽  
Vol 8 (4) ◽  
pp. 80-92
Author(s):  
O. B. Loran ◽  
A. V. Seregin ◽  
Z. A. Dovlatov
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Stress Urinary Incontinence ◽  
Long Term Results ◽  
Surgical Experience ◽  
Medium Term ◽  
Short Term ◽  
Mini Sling

Introduction. Sling urethropexy is considered the «gold standard» surgical treatment for stress urinary incontinence in women. However, the long-term results of such operations have not yet been fully studied.Purpose of the study. To evaluate the results of using various options for sling operations at different periods of postoperative follow-up.Materials and methods. In 698 women aged 42 - 68 years (median — 54 years) suffering stress incontinence were used 4 variants of sling operations according to the database of the S.P. Botkin City Clinical Hospital: TVT retropubic technique; transobturator technique TVT-O («inside-out»); transobturator technique TOT («outside-in»); mini sling system. The period of postoperative follow-up was 6 - 139 months (median 79 months). Evaluation of treatment results was carried out according to the following periods of postoperative follow-up: short-term (up to 1 year inclusive); mediumterm (a period from 1 to 5 years inclusive); long-term (over 5 years). The success of the treatment was determined by the criterion of the absence of urine involuntary loss during the cough test and the 1-hour pad test.Results. Treatment success in the entire sample of patients was 96.1% (671 / 698) for the short-term criterion, 93.1% (591 / 635) for the medium-term criterion and 86.2% for the long-term criterion (467 / 642). The effectiveness of short-term treatment after TVT was 97%, TVT-O — 95.8%, TOT — 96.2%, mini-sling system — 95.5%, in medium-term — 92.2%, 93.1%, 90.9% and 92.3%, respectively, for long-term — 87.1%, 86.2%, 85.2% and 85%, respectively. There were no significant differences between the indicated variants of sling operations in terms of treatment efficacy for all observation periods (p > 0.05). Intra and early postoperative complications were noted in 51 (7.3%) cases, late — in 79 (11.3%). There were no significant differences in the incidence of both categories of complications between the surgical techniques used (p > 0.05). Only surgical experience significantly affects the risk of recurrent urinary incontinence after surgery, early and late postoperative complications.Conclusions. The success of surgical treatment for stress urinary incontinence in women does not significantly depend on the type of sling surgery but depends mainly on the surgical experience. Therefore, it is advisable to use sling operations in hospitals with extensive experience in this area.

scholarly journals Mini Sling (Ophira) versus Pubovaginal Sling for Treatment of Stress Urinary Incontinence: A Medium-term Follow-up

2015 ◽  
Vol 116 (3) ◽  
pp. 210-218 ◽  
Author(s):  
Farzaneh Sharifiaghdas ◽  
Mahmoodreza Nasiri ◽  
Mahboubeh Mirzaei ◽  
Behzad Narouie
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Stress Test ◽  
Pubovaginal Sling ◽  
Medium Term ◽  
Induced Stress ◽  
Significant Difference ◽  
Rectus Fascia ◽  
Mini Sling

To compare two different procedures, mid-urethral mini sling (Ophira) and autologous rectus fascia sling, according to their medium-term subjective and objective outcome and satisfaction rates in the treatment of stress urinary incontinence in women. One hundred women with the main complaint of stress urinary incontinence were randomized to be treated with either mini sling (Ophira) or autologous rectus facia pubovaginal sling. Preoperative evaluation consisted of: physical examination, blood biochemistry urine analysis and culture, urinary tract ultrasound scan, conventional multi-channel urodynamic study, cystourethroscopy, cough induced stress test and Incontinence Impact Questionnaire (IIQ). The patients were objectively and subjectively re-evaluated at 1, 3, 6 and 12 postoperative months and the last visit and the collected data of more than one year follow-up were compared with preoperative assessments. Seventy two out of one hundred patients were followed for a mean time of 13.8 ± 4.4 months (12–20 months range). Objective cure rate, according to cough-induced stress test was recorded in 88.6% and 89.2% of the mini sling (Ophira) and the rectus facia sling group respectively (P=1.0). Postoperative mean IIQ score decreased to 42.7 ± 11.4 and 50.2 ± 11.1 in the mini sling (Ophira) group versus rectus facia pubovaginal sling (P=0.007). Twenty eight (80%) and 23 (67%) patients in the mini sling (Ophira) and rectus facia pubovaginal sling were satisfied with the operation (P=0.23). There is no significant difference between the mini sling (Ophira) and autologous rectus fascia sling procedure in the treatment of stress urinary incontinence at medium-term follow-up.

scholarly journals Six-year follow-up in patients with urinary stress incontinence treated with Altis® single-incision sling: a prospective single-center study

2021 ◽  
Vol 12 (2) ◽  
pp. 72-76
Author(s):  
Dakota Viruega-Cuaresma ◽  
Sonia De-Miguel-Manso ◽  
Elena García-García ◽  
Carmen E Badillo-Bercebal ◽  
Julio A Gobernado-Tejedor ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
De Novo ◽  
Single Incision ◽  
Categorical Variables ◽  
Medium Term ◽  
Single Incision Sling ◽  
Objective Cure

Objetives: Single incision slings are the latest generation of suburethral bands that seek to minimize morbidity and major complications of transobturator bands. In short and medium term, their results in terms of success and safety are similar to transobturator and retropubic bands. Nevertheless, there is little data on their long-term outcomes. Our objective was to evaluate safety and efficacy of Altis® mini-sling during the short, medium and long-term follow-up. Methods: Prospective observational study in 67 women who underwent surgery with Altis® for a period of 6 years (2013-2019). The main variables evaluated were: total continence, objective cure and subjective cure (satisfaction). The secondary variables studied were: complications and number of pads used per day after surgery. Statistics: Student t-test or U-Mann-Whitney for quantitative variables, Chi-Square for categorical variables. Results: Objective cure rates were: 96.77%, 87.04%, 87.50%, 85.71%, 76.92% and 50% (from 1 to 6years), and total continence: 85.48%, 72.22%, 64.88%, 50%, 46.15% and 50% (from 1 to 6years). Degree of satisfaction was: 9, 8.2, 8.3, 7.7, 7.6 and 6.5 points (from 1 to 6years). 30 patients (44.78%) had some type of complication and the most common were: “de novo” urinary urgency (20.90%), recurrence of stress urinary incontinence (14.93%) and pain (5.97%). Conclusion: Altis® presents high rates of objective and subjective continence in short and medium-term (1-5years), during 6-year follow-up. It is safe and does not associate severe complications. We found a high percentage of “de novo” urgency and recurrence of stress urinary incontinence, especially after the fifth year.

scholarly journals Moterų šlapimo nelaikymo chirurginis gydymas – nuo atvirųjų iki minimaliai invazinių operacijų

2003 ◽  
Vol 1 (1) ◽  
pp. 0-0
Author(s):  
Aušra Černiauskienė ◽  
Juozas Stanaitis
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Stress Urinary Incontinence ◽  
Long Term Results ◽  
Female Stress Urinary Incontinence ◽  
Burch Colposuspension ◽  
Postoperative Results ◽  
Laparoscopic Operation ◽  
Early Results

Aušra Černiauskienė, Juozas StanaitisVilniaus greitosios pagalbos universitetinė ligoninėVilniaus universiteto Bendrosios ir kraujagyslių chirurgijos klinikos Bendrosios chirurgijos centras Įvadas / tikslas Aprašyti įvairius moterų šlapimo nelaikymo fizinio krūvio metu chirurginio gydymo būdus (klasikinę kolposuspensiją Burch būdu, laparoskopinę kolposuspensiją ir "SPARC" raiščio viršgaktinę implantaciją), pateikti jų rezultatus, išanalizuoti, kokį būdą geriau pasirinkti. Metodai Vilniaus greitosios pagalbos universitetinės ligoninės Bendrosios chirurgijos centre moterų šlapimo nelaikymo gydymui 1996–2002 m. taikyti įvairūs operacijų būdai: buvo atliktos 229 atvirosios kolposuspensijos Burch būdu, 10 laparoskopinių kolposuspensijų ir dvi "SPARC" raiščio implantacijos (pouretrinis pakėlimas proleno raiščiu). Darbe pateikiami 103 ligonių, operuotų 1996–2000 m., ankstyvieji ir vėlyvieji gydymo rezultatai po atvirųjų Burch operacijų, ir 10 ligonių ankstyvieji gydymo rezultatai po laparoskopinių kolposuspensijų (1999–2001 m.). Atlikus bendruosius ir specialiuosius tyrimus (urodinaminius tyrimus, kolpocistogramas), visoms ligonėms nustatytas šlapimo nelaikymas fizinio krūvio metu. Vidutinė hospitalizacijos trukmė: po atvirosios operacijos – 14,7 dienos, po laparoskopinės – 7 dienos, po "SPARC" raiščio implantacijos – 4 dienos. Kateteris šlapimo pūslėje po atvirosios Burch opercijos buvo laikomas 5 paras, po laparoskopinės – 3, po "SPARC" raiščio implantacijos – 1 parą. Ankstyvieji operacinio gydymo rezultatai buvo įvertinti po 3 mėnesių, vėlyvieji – po 1–2, 2–3 ir 3–4 metų. Rezultatai Po atvirosios Burch operacijos ankstyvieji (po 3 mėn.) labai geri ir geri rezultatai nustatyti 96,1 % ligonių, vėlyvieji labai geri ir geri rezultatai po 1–2 metų – 87,4 %, po 2–3 metų – 84,1 %, po 3–4 metų – 81,3 % ligonių. Po laparoskopinės kolposuspensijos praėjus 3 mėnesiams, 9 ligonių rezultatai įvertinti kaip labai geri ir geri, 1 ligonės – vidutiniai (šlapimas laikosi, yra imperatyvus šlapinimasis ištekant minimaliam šlapimo kiekiui). Išvados Atvirosios ir laparoskopinės kolposuspensijos rezultatai rodo, kad šiomis operacijomis veiksmingai gydomas moterų šlapimo nelaikymas. "SPARC" raiščio implantacija – paprasta, greitai atliekama, veiksminga, sukelianti mažiau komplikacijų, tačiau brangi operacija. Prasminiai žodžiai: šlapimo nelaikymas, chirurginis gydymas, laparoskopinė kolposuspensija, pouretriniai raiščiai. Surgical treatment of female stress urinary incontinence : from open to minimally invasive operations Aušra Černiauskienė, Juozas Stanaitis Background / objective The aim of work: to describe different surgical methods in treating female stress urinary incontinence (classical Burch colposuspension, laparoscopic colposuspension and suprapubical implantation of SPARC sling), to show the results, to analyze the preferable methods. Methods 229 open colposuspensions according to Burch, 10 laparoscopic colposuspensions and 2 SPARC sling implantations (suburethral raising with prolene sling) were performed in General Surgery Clinic of Vilnius University Emergency Hospital during the period 1996–2002. We present early and long-term results for 103 patients operated on in 1996–2000 with open Burch colposuspension and early results after laparoscopic colposuspension (1999–2001). All female patients were examined (urodynamic investigation, colpocystograms) and stress urinary incontinence was diagnosed. The average hospitalization time was 14.7 days after open operation, 7 days after laparoscopic operation, and 4 days after SPARC sling implantation. Catheter from the urine bladder was removed after 5 days in case of Burch operation, after 3 days in case of laparoscopic operation, and after 1 day in case of SPARC sling implantation. Early postoperative results were assessed after 3 months, and long-term postoperative results after 1–2 years, 2–3 years and 3–4 years. Results After open Burch operations early (after 3 months) results were very good and good in 96.1% , long-term results were very good and good after 1–2 years in 87.4%, after 2–3 years in 84.1% and after 3–4 years in 81.3% of patients. After laparoscopic colposuspensions, early results were very good and good in 9 cases, medium in one case (the patient contained urine normally but complained of imperative urination with minimal urine excretion). Conclusions Our results show that both open and laparoscopic colposuspensions remain effective operations in rapidly treating female stress urinary incontinence. SPARC sling implantation is a common, quick to perform, effective operation with less postoperative complications, however, it is expensive. Keywords: urinary incontinence, surgical treatment, laparoscopic colposuspension, suburethral sling.

Osteochondritis Dissecans of the Talus: Long-Term Results of Surgical Treatment

Foot & Ankle ◽  
1989 ◽  
Vol 10 (3) ◽  
pp. 161-163 ◽  
Author(s):  
Peter Angermann ◽  
Peter Jensen
Keyword(s):  
Surgical Treatment ◽  
Osteochondritis Dissecans ◽  
Long Term Results ◽  
Short Term ◽  
Time Of Surgery ◽  
Pain At Rest ◽  
Results Of Surgery ◽  
Generalized Osteoarthritis

Twenty patients with osteochondritis dissecans of the ankle were reviewed for a clinical and radiographical follow-up 9 to 15 years after surgery including multiple drilling of the lesion combined with excision of loose fragments. The short-term results of surgery were satisfactory: 85° of the patients were improved or cured. At follow-up, more than half of the patients had some degree of pain during activity, and swelling of the ankle, but only a few had locking or pain at rest. Only one of the 18 patients without osteoarthritis at the time of surgery had developed generalized osteoarthritis at the followup. Although the initial good results of surgery were demonstrated to deteriorate with time, the procedure can still be recommended in patients with longstanding symptoms.

scholarly journals Incisionless Pubovaginal Fascial Sling Using Transvaginal Bone Anchors for the Treatment of Stress Urinary Incontinence

2004 ◽  
Vol 4 ◽  
pp. 357-363 ◽  
Author(s):  
Sandip P. Vasavada ◽  
Craig V. Comiter ◽  
Shlomo Raz
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Minimally Invasive ◽  
Urge Incontinence ◽  
Bladder Neck ◽  
Long Term Results ◽  
Invasive Technique ◽  
Fascial Sling

Introduction: Bladder neck suspension (BNS) for stress urinary incontinence (SUI) can have significant morbidity, including bleeding, infection and pain. In an effort to reduce this potential morbidity, we have devised a technique which provides the same suburethral support as a standard anterior vaginal wall sling (AVWS), but without a vaginal or suprapubic incision. We describe this minimally invasive technique. Methods: From April 1998 to February 1999, 85 women underwent an incisionless suburethral fascial sling procedure. A transvaginal bone drill was used to place a bone anchor loaded with #1 prolene suture into the inferior aspect of the pubic bone on either side of the urethra. A subepithelial tunnel was created at the level of the bladder neck. A 2 x 7 cm segment of cadaveric fascia lata was placed through the subepithelial tunnel. The sutures were passed through the fascia 5mm from either edge, effectively creating a 6.0 cm sling. Finally, the sutures are tied up to the pubic symphysis.Results: Follow-up was via a self-administered questionnaire and patient interview. Recurrent SUI was noted in 2/85 (3%). New onset urge incontinence was present in 4/85 (5%). Permanent urinary retention has not occurred in either group. All procedures were performed on an outpatient basis and no operative complications occurred.Conclusions: Early results for the incisionless sling compare favorably with the long term results for the AVWS. This minimally invasive approach has thus far not been associated with any significant complications. Elimination of the vaginal and suprapubic incisions has not compromised efficacy, and appears to reduce the incidence of urge incontinence. Long term follow-up will establish the lasting efficacy of this novel surgical technique.

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