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

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

Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis

Objective To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. Data Sources We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. Data Collection Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. Data Synthesis Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05–1.54) and subjective (OR, 1.23; 95% CI, 1.02–1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39–0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50–2.77) and subjective (OR, 1.64; 95% CI, 1.10–2.44) cures, favoring pubovaginal sling. There was no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. Conclusion Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.

Pelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up

Objective Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results. Methods A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons. Results Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630). Conclusions The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.

Minimally Invasive Surgery for Stress Urinary Incontinence – Mesh Complications

Currently, the most commonly performed surgeries for stress urinary incontinence (SUI) are mesh midurethral slings (MUS). They are minimally invasive outpatient procedures, and they are as effect-tive as traditional suburethral slings, open retropubic colposuspension (Burch, Marshall-Marchetti), and laparoscopic retropubic colposuspension. They have a short operative time and fewer postoperative complications. In the paper we present results from a prospective study of 214 patients with SUI who underwent midurethral sling placement: 68 patients with retropubic slings (TVT) and 146 patients with transobturator slings (TVT-O) followed over 12 months. The operations were performed at the Department of Obstetrics and Gynaecology at the Medical Faculty, Skopje, R. Macedonia and at the Department of Obstetrics and Gynaecology, General Hospital, Sibenik, Croatia. All MUS placements (TVT and TVT-O) were performed by one surgeon (urogynaecologist) using the standard surgical technique and operative and postoperative protocol for those procedures. TVT and TVT-O meshes are polypropylene macroporous meshes produced by “Ethicon” We evaluated mesh complications related to the procedure (Table 1) and complications specific to the mesh (Table 2). In the article are presented the data from up-to-date literature related to the evaluated topic parallel to our results. We can conclude that all our findings on the evaluated groups are comparable with the data from competent literature. Instead of a conclusion we would like to suggest continuous follow-up of all minimally invasive procedures with midurethral slings placement for collecting experience of side-effects and complications and improving those procedures which are gold standard today in the treatment of SUI.