The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country

Objectives: To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI). Methods: We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6). Results: Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure. Conclusions: All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI. doi: https://doi.org/10.12669/pjms.37.5.4017 How to cite this:Abrar S, Razzak L, Mohsin R. The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4017 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Long-Term Results after Suprapubic ARC Procedure for the Treatment of Stress Urinary Incontinence in Women: A Retrospective Data Analysis

<b><i>Introduction:</i></b> The aim of this study was to evaluate long-term safety and efficacy of the suprapubic arc (SPARC) procedure for the surgical treatment of stress urinary incontinence (SUI). <b><i>Materials and Methods:</i></b> 139 female patients treated by SPARC were included in this retrospective analysis, whereby 126 patients were available for follow-up after 1 year, 70 after 6 years, and 41 after 9 years. The cough test, pad test, uroflowmetry, and post-void residual volume measurements were performed. Severity of bother (visual analogous scale [VAS] 0–10), continence, and the satisfaction rate were assessed. Objective cure was defined as a negative cough test and pad weight ≤1 g, subjective cure as no urine loss during daily activities and no usage of pads. The VAS, pad weight, number of pads per day, and maximal flow rate were compared preoperatively and postoperatively. <b><i>Results:</i></b> Objective cure rates at 1, 6, and 9 years were 78.6, 71.4, and 70.7% and subjective cure rates were 72.2, 55.7, and 65.8%, respectively. The VAS, pad weight, number of pads, and maximal flow rate decreased significantly. Study limitations include a relatively small sample size and the retrospective fashion of the analysis. <b><i>Conclusions:</i></b> In the long-term context, SPARC showed to represent an efficient and safe procedure for treatment of female SUI.

Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

Abdominal sacral colpopexy/hysteropexy is the gold standard for the treatment of vaginal apex support. However, dissection of the promontory may expose to potentially life-threatening complications. To avoid this risk, laparoscopic lateral suspension with mesh is an alternative. Robotic assistance may be helpful in both techniques. The objective of our study was to evaluate outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical pelvic organ prolapse (POP). From March 2012 to January 2018, 59 consecutive patients underwent RALLS using titanized polypropylene mesh. Between August 2017 and September 2019, all patients were contacted to assess outcome. We performed a clinical exam and asked them to complete the patient global impression of improvement (PGI-I) questionnaire. Fifty-four patients (91.5%) were available for follow-up. Mean age was 58.5 years (28.8–79.8). There were no perioperative complications. The mean follow-up was 33.6 months (11.2–74.1).The objective cure rate (no prolapse beyond hymen) and the subjective cure rate (PGI-I ≤ 2) were 83.3% and 77.2%, respectively. Five women (9.3%) were reoperated for POP recurrence. There was no erosion. Of the 20 women complaining of stress urinary incontinence (SUI) preoperatively, 12 (60%) were cured without any additional SUI procedure. Only two women (10%) required TVT for persistent grade 2 SUI. Two women (5.9%) developed de novo SUI, but none of them required an operation. RALLS repair for POP with mesh is safe and effective and may represent an alternative to sacral colpopexy/hysteropexy.

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.

Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial

Objective Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse. Methods In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. Results After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002). Conclusion Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.

A modified technique for paravaginal repair for the treatment of anterior vaginal prolapse and cystocele：a retrospective study

Background: We aimed to determine the efficacy and safety of a modified protocol for paravaginal repair for treating symptomatic paravaginal defects and cystocele. Methods: This study was an observational case series of 98 consecutive female patients, referred to our hospital between June 2014 and May 2018, with symptomatic grade II to IV paravaginal defects and cystocele. Our modified technique for paravaginal repair is based on the conventional protocol but incorporates reverse bridge repair and the cross-stitching of bilateral sutures. The curative effect of this new technique was evaluated subjectively and objectively during postoperative follow-up. Results: All operations were successful. Patients were followed up for 12 to 48 months, until June 2019; the mean follow-up period was 32.4 months. Three months after surgery (98 cases), the subjective cure rate was 100%; in each case, the top of the vagina lay above the level of the sciatic spine. The objective cure rate was 100%. The objective cure rate was 94.9% (93 cases) twelve months after surgery (98 cases), 91.0% (61 cases) twenty-four months after surgery (71 cases), and 76.2% (16 cases) forty-eight months after surgery (21 cases). Four cases required a second round of surgery; three of these cases were treated with sacrocolpopexy, and one case was treated with sacrospinous ligament fixation. Conclusion: Our modified technique for paravaginal repair was safe and effective for the treatment of anterior vaginal prolapse and cystocele, as confirmed by the results observed over a mean follow-up period of 32.4 months.

Medium-Term Outcomes of Laparoscopic Pubocervical Fascia Reconstruction and Sacrospinous Ligament Fixation for Pelvic Organ Prolapse

Background: The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for severe pelvic organ prolapse (POP). Methods: A total of 129 patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at Sir Run Run Shaw Hospital College of Medicine, Zhejiang University, Hangzhou, China between September 2014 and December 2018 were enrolled in this study. One hundred twenty-four patients were followed up for at least 1 year. The results and complications were recorded. Data were retrospectively reviewed. Results: All the patients underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach. The average follow-up time was 32.27±12.90 months. The objective cure rate for those who underwent hysterectomy was 91.7 % (100/109), and no patient experienced apical vaginal prolapse. The objective cure rate for those who retained uterus was 66.67% (10/15). Suture-related complications were recorded.Conclusions: Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe, minimally invasive, and effective method for patients with severe POP. Long-term follow-up is required to confirm the clinical effects.

A modified technique for paravaginal repair for the treatment of anterior vaginal prolapse and cystocele: a retrospective study

Background We aimed to determine the efficacy and safety of a modified protocol for paravaginal repair for treating symptomatic paravaginal defect cystocele. Methods This study was an observational case series of 98 consecutive female patients, referred to our hospital between June 2014 and May 2018, with symptomatic grade II to IV paravaginal defects and cystocele. Our modified technique for paravaginal repair is based on the conventional protocol but incorporates reverse bridge repair and the cross-stitching of bilateral sutures. The curative effect of this new technique was evaluated subjectively and objectively during postoperative follow-up. Results All operations were successful. Patients were followed up for 12 to 48 months, until June 2019; the mean follow-up period was 32.4 months. Three months after surgery (98 cases), the subjective cure rate was 100%; in each case, the top of the vagina lay above the level of the sciatic spine. The objective cure rate was 100%. The objective cure rate was 94.9% (93 cases) twelve months after surgery (98 cases), 91.0% (61 cases) twenty-four months after surgery (71 cases), and 76.2% (16 cases) forty-eight months after surgery (21 cases). Four cases required a second round of surgery; three of these cases were treated with sacrocolpopexy, and one case was treated with sacrospinous ligament fixation. Conclusion Our modified technique for paravaginal repair was safe and effective for the treatment of anterior vaginal prolapse and cystocele, as confirmed by the results observed over a mean follow-up period of 32.4 months.

Long term outcomes of Burch colposuspension and transobturator tape and single incision needleless (DynaMesh®- SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy

Background Women with SUI often require combined pelvic reconstructive surgery because of sharing risk factors of pelvic relaxation. The aim of this study was to evaluate the efficacy of Burch colposuspension, the transobturator tape (TOT), and single incision needleless (DynaMesh®- SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. Methods We carried out a prospective cohort study that included 142 patients who underwent Burch colposuspension (n:43), TOT(n:40), or SIS(n:39) procedures combined pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During clinical follow-up, objective cure, subjective cure, failure and surgical success rates were analyzed. Quality of life and symptom severity were assessed by IIQ-7, UDI-6, OAB-V8, SSI, SSQ-8 and PGI-I. Primary outcome was surgical success which was defined when any of the objective cure, subjective cure or improvement has achieved and secondary outcomes were; intraoperative bladder injury, sling extrusion, de novo urgency, voiding dysfunction, length of hospital stay, and outcomes of patient reported quality of life questionnaires. Results Surgical success rate were higher in Burch group than SIS group and also higher in TOT group than SIS group (88,4% vs 61,5% and 87,5% vs 61,5% respectively, p=0,003) Urinary incontinence complaints were higher and quality of life were lower in in SIS group when compared with Burch group. No difference was seen in between Burch and TOT groups, and TOT and SIS groups in terms of IIQ-7, UDI-6, OAB-V8, SSI, and SSQ-8 scores. Conclusions Both Burch and TOT were safe and effective procedures in patients with SUI who required additional pelvic surgeries. Although surgical outcome of SIS procedure in SUI patients that had concomitant pelvic surgeries in our study was not promising, the data are not clear and further randomized studies are needed to clarify these observations.

Patient satisfaction and objective outcome assessment following mid-urethral sling procedures in women with stress urinary incontinence: A prospective study

Background Mid-urethral sling (MUS) operations are currently a recognized as the most popular and effective procedures for the surgical treatment of stress urinary incontinence (SUI) among women population. However, data reporting a long-term outcome is still equivocal, and thus, the data available are limited. This study aims to examine the efficacy of MUS operations after implantation for the treatment of women SUI during 3-years follow up. Method A prospective study was conducted in referral centers in the Tehran University of Medical Science, Emam Khomeini Hospital, Iran. 105 patients with urodynamically proven pure SUI or mix incontinence treated by MUS surgeries (TOT-TVT) were included. Patients with history of prior anti-incontinence surgery and abdominal radical pelvic surgery were excluded. Data regarding objective cure rates, subjective outcomes (Urogenital Distress Inventory Questionnaire–Short Form, Surgical Satisfaction Questionnaire) were collected during follow-up. We analyzed the preoperative parameters by univariate and multivariate analysis was conducted to investigate outcomes. Results One hundred five women had MUS implantation. At 4-years follow-up, 101 women (95%) were available for the assessment. We find evidence of significant improvement in urinary symptoms, objective cure rates and patient satisfaction after operation. At 3-years follow up, 80 of 101 women (82.17%) indicated themselves cured. Similarly, at 3-years evaluation, 83 of 101 women (82.17%) were satisfied or very satisfied, not showing visible urine leakage; and a state that did not need interval surgery. The multivariate analysis of the preoperative parameters revealed that age, VD, absences of urgency symptoms were the parameters related independently to the surgical success and patient’s satisfaction and Qmax was well associated with postoperative voiding dysfunction (PVD). Conclusion The 4-years findings of this study suggest that MUS surgeries are an effective procedures for the treatment of SUI.