scholarly journals Success of Custommade Transobturator Slings Prepared From Conventional Polypropylene Mesh in the Treatment of Stress Urinary Incontinence in Women

2020 ◽  
Vol 18 (2) ◽  
pp. 49-55
Author(s):  
ATM Mowladad Chowdhury ◽  
Ahmed Bakhtiar ◽  
Pervin Sayeeda ◽  
Kamrun Nahar ◽  
Begum Mossamat Maksuda
Keyword(s):  
Polypropylene Mesh ◽  
De Novo ◽  
Menopausal Status ◽  
Operation Time ◽  
Transobturator Tape ◽  
Transobturator Slings ◽  
De Novo Urgency ◽  
Polypropylene Monofilament ◽  
Body Mass Indexes

Objective: To observe the outcome of the transobturator tape, using custommade slings prepared from conventional polypropylene mesh in women in management of SUI. Materials and Methods: This prospective observational study was carried out from June 2010 to April 2015 among 35 patients who underwent the TOT procedure using handmade (polypropylene monofilament) slings; and complete at least the 12 month follow up period. Medical history, demographic characteristics, body mass indexes (BMI), menopausal status of patients, operation time, cost of sling, success of operation and complications were recorded. Before the operation, all patients were confirmed SUI through physical examination, urinalysis, urodynamic studies and ultrasonography. Placement of the sling to the midurethra was done in manner as described by Delorme. All the data were analyzed. Results: There were 35 patients with mean age 51.23 ± 5.63years, BMI 26.14 ± 3.70 kg/m². Twenty of the patients post were menopausal. The cost of the sling was 1200 BDT (15 USD). The success rate of TOT 12 months after surgery and at the last follow up was 91.5% and 88.6% respectively. Postoperative obstruction was noted in 2 patients, vaginal extrusion occurred in one case, de novo urgency and urinary tract infection (UTI) occurred in 2 patients. All of them were managed successfully with conservative treatments. There was no other early or late postoperative complication. There was significant improvement of the QoL and statistically no significant decrease in the Q max during the follow up period. Conclusion: Custommade mesh is a reasonable option in TOT surgery with good efficacy and cost effectiveness and complication like vaginal extrusion is also minimum. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.49-55

scholarly journals Safety and efficacy of surgical transobturator tape in the treatment of stress urinary incontinence in women - three years of follow-up

2021 ◽  
pp. 107-107
Author(s):  
Milos Pantelic ◽  
Marko Stojic ◽  
Aleksandar Curcic ◽  
Miso Dukic ◽  
Uros Kadic ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
De Novo ◽  
Elderly Women ◽  
Stress Test ◽  
Physical Exertion ◽  
Transobturator Tape ◽  
Leg Pain ◽  
Objective Stress

Introduction/Objective. Stress urinary incontinence (SUI) is defined as the complaint of involuntary loss of urine in effort or physical exertion, or on sneezing or coughing. It is a common clinical condition affecting 50% of middle-aged and elderly women. Mid-urethral slings (MUSs) are the gold standard in the treatment of SUI. The aim of this study was to investigate the success rate and complications of surgical treatment of SUI in women with transobturator tape (TOT) within the three years of follow-up. Methods. From January 2011 until January 2018, 86 women with predominantly SUI were operated by TOT procedure. In 61.6% of patients SUI was confirmed by preoperative urodynamic examination (cystometry, uroflowmetry, urethral presser profile) and in 38.4% of patients by clinical examination of stress test (cough provocation). All patients were invited for a follow-up examination 6, 12, 24 and 36 months after surgery. The result of the operation is defined as cured, improved or without success. Results. The average age was 55 (32-72) years. The most common complications were tape erosion (3.5%), incision bleeding (2.3%), transient leg pain (3.5%), dyspareunia (2.3%), vaginal erosion (3.5%) and de novo urge (5.8%). After three years of follow-up, 82.6% patients were cured. Conclusion. TOT is a safe, effective and successful procedure with 82.6% of cured patients during a three-year follow-up.

scholarly journals Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up

2018 ◽  
Vol 67 (3) ◽  
pp. 55-63
Author(s):  
Dmitry D. Shkarupa ◽  
Nikita D. Kubin ◽  
Eduard N. Popov ◽  
Ekaterina A. Shapovalova ◽  
Gleb V. Kovalev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
De Novo ◽  
Urine Volume ◽  
Operation Time ◽  
Pelvic Organ ◽  
Stage Ii ◽  
Apical Prolapse ◽  
Pelvic Floor Reconstruction

Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient  effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction. Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse. Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment. Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.

TVT and TOT: a comparison between these two techniques based on our clinical experience

2008 ◽  
Vol 75 (4) ◽  
pp. 232-236
Author(s):  
A. Tamai ◽  
A. Donazzan ◽  
V. Gallo ◽  
S. Durante
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Voiding Dysfunction ◽  
De Novo ◽  
Single Side ◽  
De Novo Urgency ◽  
Group A ◽  
Group B

Aim of the Study A retrospective evaluation and a comparison of results from two minimally invasive surgery techniques that we adopted for the treatment of SUI. Materials and Methods. In this study we evaluated 113 selected patients who underwent SUI minimally invasive surgery from 1–1-2000 to 31–12–2007. 87 patients underwent epidural anesthesia. 26 local anesthesia. In Group A (TVT) 61 patients were enrolled, mean age 57.6 (±22). 43 patients (70%) were on menopause. In Group B (TOT out-in) 52 patients were enrolled (for 34 of them we used the Obtape® sling while for 18 the Obtryx® one), their mean age was 58.5 (±20.5) and 39 patients (75%) were on menopause. Patients from both groups did not undergo any past previous urogynecological surgery and suffered from stress urinary incontinence with cervico-urethral hypermobility butno other associated pathology. The pre-operative work-up included an evaluation of patients based on ICS guidelines. Results. Group A (TVT) - mean follow-up 66.3 months, dry patients 53/61 (86.8%). Bladder perforations resolved by catheterization 3/61 (5%). Transient voiding dysfunction 14/61 (22.8%). “De novo” urgency 8/61 (13%). One patient on self-catheterization due to persistent urinary retention underwent a single-side section of the sling with spontaneous micturition and complete continence recovery. Group B (TOT out-in) - mean follow-up 35.5 months, dry patients 43/52 (82%). 4 patients (7.6%) complained oftransient voiding dysfunction, 5 patients (9.5%) for “de novo” urgency, 1 patient underwent a sling removal due to vaginal erosion 4 months after surgery (Obtape®).

scholarly journals Our Minimally Invasive Sacrocolpopexy Experiences in Pelvic Organ Prolapse Treatment

2021 ◽  
Author(s):  
Kamil Gökhan Şeker ◽  
Emre Sam ◽  
Yusuf Arıkan ◽  
Ahmet Hacıislamoğlu ◽  
Abdulmuttalip Şimşek ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Minimally Invasive ◽  
Operative Time ◽  
De Novo ◽  
Treatment Success ◽  
Conservative Surgery ◽  
Pelvic Organ ◽  
Robotic Sacrocolpopexy ◽  
De Novo Urgency

Objective: We aimed to evaluate the results of our minimally invasive (laparoscopic and robotic) sacrocolpopexy operations in patients with pelvic organ prolapse (POP). Materials and Methods: Demographic characteristics, intraoperative and postoperative data of 15 patients for whom we applied laparoscopic or robotic sacrocolpopexy due to symptomatic Grade 2 or higher apical POP based on POP-Q classification between September 2014 and September 2018. Treatment success was defined as Grade 0 or 1 POP in POP examination in the final surveillance. Results: Mean age of the patients was 60.4 ± 8.3 (49-82) years. Four patients (26.7%) were operated using robotic and eleven patients (73.3%) using laparoscopic methods. Uterus conservative surgery was applied in all patients excluding one. Mean operative time was 183.3 ± 21.4 (145-220) minutes and mean hospital stay of the patients was 2.8 ± 0.7 (2-4) days. Intraoperative and postoperative complications developed in a total of two patients (13.3%). Mean duration of follow-up was calculated as 12.1 ± 4.8 (8-24) months. De novo urgency urinary incontinence developed in two patients and stress incontinence in one patient. Based on the physical examination in the follow-ups, 14 patients (93.3%) had Grade 0 and one patient had (6.7%) asymptomatic Grade 2 anterior POP. Conclusion: Minimally invasive sacrocolpopexy is an efficient and safe surgical option for prolapse repair in symptomatic advanced stage POP cases.

scholarly journals Tension-free Vaginal Tape vs Tension-free Obturator Tape for Treatment of Genuine Stress Urinary Incontinence: A 5-year Follow-up

2017 ◽  
Vol 9 (2) ◽  
pp. 95-99
Author(s):  
Priyanka Bhadana
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
De Novo ◽  
Uterovaginal Prolapse ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
Genuine Stress Urinary Incontinence ◽  
Patients With Diabetes ◽  
De Novo Urgency

ABSTRACT Objective To compare the effectiveness of tension-free vaginal tape (TVT) and tension-free obturator tape (TOT) in treatment of genuine stress urinary incontinence and study the related complications. Materials and methods About 150 cases with complaints of stress urinary incontinence were taken during 5-year period, and they were confirmed urodynamically. Exclusion criteria included patients with diabetes mellitus, neurological disorders, other forms of incontinence, uterovaginal prolapse, urinary tract infection, and pregnancy. Out of 150 cases, 70 underwent TVT procedure and 80 were taken up for TOT. The outcome was studied at the end of 5 years. Results The cure rate in the TOT group was 94%, which was slightly higher than the TVT group, which came out to be 90%. The failure rate in the TVT group was 1.1%, but no failure was encountered in the TOT group. However, the improvement rates were similar in each group. Comparing the complications in each group, the rate of bladder perforation and postoperative retention of urine was much higher in the TVT group. Postoperative voiding difficulties were also noticeably less in TOT group compared with TVT group. However, none of the cases in either group had de novo urgency. Conclusion Both the procedures are a safe and effective method of curing stress incontinence; however, owing to slightly higher improvement rates and lower complications rate, TOT should be preferred over TVT. How to cite this article Bhadana P, Mittal P, Bachani S. Tension-free Vaginal Tape vs Tension-free Obturator Tape for Treatment of Genuine Stress Urinary Incontinence: A 5-year Follow-up. J South Asian Feder Obst Gynae 2017;9(2):89-93.

Mini-Slings: Do They Stand the Test of Time? A 10-Year Cohort

2020 ◽  
pp. 1-5
Author(s):  
Margarida Manso ◽  
Francisco Botelho ◽  
Carlos Silva ◽  
Francisco Cruz
Keyword(s):  
De Novo ◽  
Treatment Success ◽  
Anticholinergic Drugs ◽  
Patient Global Impression ◽  
High Satisfaction ◽  
Patient Reported ◽  
De Novo Urgency ◽  
Satisfaction Rates ◽  
Mini Sling

<b><i>Introduction:</i></b> It is known that failures after midurethral slings increase with the follow-up time. Nevertheless, data concerning mini-slings are sparse. To clarify this statement, we analyze a mini-sling cohort with a median follow-up of 10 years. Although the brand used, MiniArc<sup>®</sup>, is no longer available, an identical device, Solyx™, can still be used, which makes the analysis of the cohort clinically relevant. <b><i>Material and Methods:</i></b> A total of 172 women with predominant stress urinary incontinence (SUI) were consecutively treated with the mini-sling MiniArc<sup>®</sup> from 2006 until 2013. They were reevaluated in 2018. The primary outcome, treatment success, was defined as no self-reported SUI symptoms and no reintervention. Secondary outcomes included the response to patient-reported outcomes. Adverse events were assessed. <b><i>Results:</i></b> After a median follow-up time of 113 months, 115 (66.9%) women were available for reevaluation. Forty-four (38.3%) women self-reported SUI. Seventeen women had been reoperated, 14 (12.2%) due to the reappearance of SUI and 3 due to complications. Altogether, MiniArc<sup>®</sup> had an overall success rate of 47.0% at 10 years. Among those not reoperated, 63.3% stated that they were much better or very much better in Patient Global Impression of Improvement (PGI-I) and 71.4% affirmed that their continence problem was normal or mild in Patient Global Impression of Severity (PGI-S). Almost 85% would repeat the surgery. Reoperation due to complications was rare (2.6%). De novo urgency appeared in 30.6% of the patients and it was managed with anticholinergic drugs with favorable outcomes. <b><i>Discussion/Conclusion:</i></b> This report adds evidence to the long-term outcomes of mini-slings, confirming that they can cure or improve SUI and give patients high satisfaction rates, at the expense of low morbidity.

scholarly journals TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Rosita Aniuliene ◽  
Povilas Aniulis ◽  
Darijus Skaudickas
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Midurethral Sling ◽  
Randomized Study ◽  
Menopausal Status ◽  
Operation Time ◽  
Female Stress Urinary Incontinence ◽  
One Year ◽  
Complications Rate

AbstractObjectives: The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). Methods: A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients – using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Results: Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact – at 94.5% and SLING-IUFT – at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLINGIUFT group. Conclusion: the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVTExact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Modified Technique of Doubly Folded Peritoneal Flap Interposition in Transabdominal Vesicovaginal Fistula Repair: Our Experience of 36 Cases

2020 ◽  
Vol 104 (11-12) ◽  
pp. 928-932
Author(s):  
Shashi Kant Tewary ◽  
Ranjit Kumar Das ◽  
Arpan Choudhary ◽  
Supriyo Basu ◽  
Ranjan Kumar Dey
Keyword(s):  
Vesicovaginal Fistula ◽  
Operative Time ◽  
Open Repair ◽  
De Novo ◽  
Modified Technique ◽  
Suitable Alternative ◽  
Peritoneal Flap ◽  
Estimated Blood Loss ◽  
De Novo Urgency

<b><i>Purpose:</i></b> Correction of vesicovaginal fistula (VVF) using interpositional flaps is an established procedure. In open repair, omental flap gives good results. However, its availability in all the cases is questionable. We utilized our technique of doubly folded peritoneal flap and assessed the outcome of the repair. <b><i>Methods:</i></b> Retrospective observational study included 36 cases of open VVF repair, performed during 2010–2019. Preoperative clinical examination, cystoscopy, and imaging were performed routinely. Open transvesical repair as described by O’Conor was performed and doubly folded peritoneal flap was utilized. Intra- and postoperative parameters were recorded. The outcome was assessed after 21 days of catheter removal. A minimum of 6 months of follow-up was done. <b><i>Results:</i></b> Mean age was 44 ± 18 years, and 97.2% of VVF were iatrogenic, mainly after hysterectomy (75.0%) and caesarean section (22.2%). Fistula size ranged from 0.6 to 5.5 cm. Five cases had multiple fistulas and 3 cases were recurrent. Mean flap length and width were 8.0 ± 2.4 and 5.1 ± 1.1 cm, respectively. Mean operative time and estimated blood loss were 94 ± 15 min and 155 ± 45 mL, respectively. Fourteen of 36 patients developed complications of Clavien-Dindo grade I/II. Thirty-five out of 36 cases (97.2%) were cured and remained dry for 6 months after surgery. Three cases reported de-novo urgency and were treated medically. Satisfaction level was good in 91.2% of cases. <b><i>Conclusion:</i></b> Transvesical repair using doubly folded peritoneal flap provides an excellent and durable outcome. It is a suitable alternative to the omental interpositional flap.

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