Therapiemöglichkeiten der weiblichen Belastungsinkontinenz

ZusammenfassungDie Jahrtausendwende ging in Bezug auf das Thema weibliche Inkontinenz mit vielen wesentlichen Änderungen einher, der Begriff Stressinkontinenz wurde von Belastungsinkontinenz abgelöst, die Integraltheorie von Petros u. Ulmsten sowie das Hammock-Modell von DeLancey erweiterten das Verständnis der weiblichen Inkontinenz, das TVT (Tension-free vaginal tape) setzte sich in kurzer Zeit weltumspannend als Therapiestandard durch. Die vielversprechend gestartete Stammzelltherapie wird trotz inzwischen vorliegender klinischer Studien kontrovers beurteilt. Etablierte Therapieverfahren sind zunächst die konservative Therapie mit gezieltem Beckenbodentraining, minimal-invasive Verfahren wie die suburethrale Injektion, klassische Operationsverfahren wie die Faszienzügelplastik und die Kolposuspension mit ihren Modifikationen sowie die alloplastischen suburethralen Bänder (TVT, TOT [Transobturator tape], SIS [Single incision sling]), entweder spannungsfrei oder adjustierbar. Die Operationsmethoden liefern auch im Langzeitverlauf insgesamt gute Ergebnisse bei geringerer Morbidität der Bandverfahren. In Anbetracht der weltweiten Zulassungsbeschränkungen alloplastischer Bänder sollten die urogynäkologische Expertise in klassischen Operationstechniken aufrechterhalten werden und neue Entwicklungen den IDEAL (Innovation, Development, Exploration, Assessment, Long-term study)-Empfehlungen folgen.

A retrospective evaluation after insertion of the MicroGYNious single incision sling in cases of stress urinary incontinence

In the literature the rate of stress incontinence is reported between 29-75%. Compared to the established tension free vaginal tapes, the question arises, whether stabilization of the urethra can also be achieved by minimally invasive single incision slings. The aim of this retrospective analysis is to evaluate the cure rate after insertion of MicroGYNious sling. The study was carried out on 115 patients, who received a MicroGYNious sling. It was used both as a single operation for stress urinary incontinence and as a combined procedure. The degree of incontinence preoperatively and continence rate postoperatively with follow-ups (6 weeks, 6 months, one year, two years and three years) were recorded. Due to a high number of lost to follow-up after one year, only the data up to one year postoperative were included in the analysis. Preoperatively, grade I incontinence was found in 6.1%, grade II 35.7%, grade III 58.3% of the operated women. The continence rate was 96.7% postoperatively, 90 % after 6 weeks, 87.2 % after 6 months, 86.7% after one year. In terms of continence rates, the MicroGYNious sling shows similar results compared to the established procedures. Therefore, this sling provides a good treatment option for the stress urinary incontinence. These good results must be confirmed in prospective randomized trials.

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

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.

Treatment of female stress urinary incontinence with transobturator suburetral band compared with single incision sling: 7-year follow-up

Objetives: Compare the efficacy and post-surgical complications of single-incision sling (SIS) and transobturator band (TO) for the treatment of stress urinary incontinence (SUI) over 7 years’ follow up. Methods: This is a prospective observational study that included 289 women with SUI who went under surgical treatment, either TO (109) or SIS (180). Patients were evaluated pre- and postoperatively through anamnesis, physical examination and ultrasound. Epidemiological information, complications and surgical time were recorded. The primary outcomes were total continence, objective and subjective cure rates at 7-year follow-up. Statistics: T-Student or U-Mann-Whitney for quantitative variables, Chi-Square for qualitative variables. Results: The groups were similar regarding demographic and medical history parameters, except for age and arterial hypertension, which were higher in TO group, and that SIS patients were more physically active tan TO patients. The TO band compared to SIS associated with increased frequency repair of pelvic organ prolapse. Depending on the type of urinary incontinence, pure SUI was more frequent in SIS and mixed in TO. The duration of the surgery was shorter with SIS. During the 7-year follow up there were no differences in the objective cure, subjective cure and complication rates. Conclusion: After 7-years follow-up, no significant differences were found with regard to subjective and objective outcomes, and post-surgery complication rates between the single incisión sling and the transobturator band.