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

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.

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

<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^®, 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^® 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^® 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.

Complications after different surgical methods for suburethral implantation of polypropylene slings in women with stress urinary incontinence

Objective: to identify the proportion of complications after suburethral implantation of polypropylene slings in women with stress urinary incontinence based on a seven-year experience. Material and Methods. We conducted the analysis of а seven-year experience in various implantation techniques of suburethral slings in 1260 women with stress urinary incontinence: inside-out and outside-in obturator sling fixation; suprapubic sling fixation and non-trocar mini-sling installment. Results. The highest incidence of complications was observed over the first two years after suburethral sling implantation was performed. Subsequently, the proportion of complications declined progressively to the lower limit values of 7-8% in the course of three last years. An incidence of early surgical complications among various suburethral sling implantation techniques had no statistically significant differences. However, after the suprapubic sling implantation, intraoperative and mesh-associated complications prevailed. Conclusion. Our study confirmed that suburethral sling implantation using suprapubic fixation method was associated with a higher incidence of complications and should have been performed exclusively for the target group of the patients, for whom safer surgical procedures were contraindicated.

Risk factors of recurrence of stress urinary incontinence after single-incision sling at 5 years

Introduction and hypothesis: Stress urinary incontinence (SUI) affects 5-35% of women, especially at menopause. In severe cases or when conservative treatment fails, a tensión-free suburethral band is indicated. Similar short-medium term cure rates have been reported with mini-sling (SIS) compared to retropubic and transobturator band. But the long-term information is scarce and it seems that the risk of recurrence is not negligible (4-37%). There is little literatura that studies the posible predisposing factors for the recurrence of SUI after SIS. The objective is to identify factors associated with the risk of relapse of SUI at 5 years, after SIS. Methods: A prospective five-years follow-up observational study (2015-2019) was performed in women who underwent SUI using SIS. The sample was 115 patients with relapse of SUI. Statistics: T-Student or U-Mann and ROC for quantitative variables, Chi-Squared and OR for qualitative variables. Results: L25 patients (21.74%) had recurrence during the study period. Of all the variables analyzed, they only showed a significant association with the recurrence of SUI: height, weigth and BMI, a history of fetal macrosomia and the number of compresses used. The patients who presented recurrence of SUI had a lower heigth, greater weight, and therefore a higher BMI. The obstetrics history of a vaginal delivery with a fetus >4 kg, was associated with a higher risk of recurrence (OR: 4.05, IC 95%=1.09-15.03), and the use of a greater number of compresses was also associated with an increased risk of relapse, obtaining an area under the curve of 0.659. Conclusion: The 5-year recurrence rateo f SUI after mini-sling in our setting was 21.74%. A lower height, a greater weight and BMI, macrosomic delivery and greater number of purses have shown a significant association with the risk of relapse of SUI after mini-sling at 5 years. Therefore, it is essential to adecuately advise patients according to their personal factors of the potencial risk of recurrence after SIS.